Coeliac Disease
Introduction
Coeliac disease is a digestive disease that
damages the small intestine and interferes with absorption
of nutrients. Patients with coeliac disease develop intolerance
to a protein called gluten, which is found in wheat, rye,
barley and oats. In such patients, when gluten is ingested
the immune system responds by attacking the cells lining
the small intestine. Specifically, tiny finger-like protrusions,
called villi, are lost. These villi play a key role in the
absorption of nutrients into the bloodstream. Without them,
malnutrition ensues regardless of the quantity of food consumed.
Coeliac disease is also known as coeliac sprue,
nontropical sprue, and gluten-sensitive enteropathy. Because
the body's immune system causes the damage, coeliac disease
is considered an autoimmune disorder. It is also classified
as a disease of malabsorption.
The prevalence of coeliac disease in Australia
may be as high as 1 in every 500 people. Patients may develop
initial symptoms as children or adults. Coeliac disease
is sometimes triggered or becomes active for the first time
after surgery, pregnancy, childbirth, viral infection or
severe emotional stress. One factor contributing to the
development of coeliac disease may be breastfeeding during
infancy - patients breastfed for a significant period of
time tend to develop symptoms of coeliac disease later and
have more atypical symptoms than those not breastfed as
a child. The disease does not appear in children until after
they begin eating gluten.
Symptoms
Coeliac disease may be asymptomatic in some
patients where the undamaged part of the small intestine
is able to absorb enough nutrients to prevent symptoms.
There is no typical presentation. Common gastrointestinal
symptoms include chronic diarrhoea, abdominal discomfort,
bloating and distension. Symptoms may or may not occur in
the digestive system. For example, one patient might have
diarrhoea and abdominal pain, while another patient may
complain of irritability or depression. In fact, irritability
is one of the most common symptoms in children. Many symptoms
(eg. fatigue, anaemia, weight loss, bone pain, delayed growth
and failure to thrive in infants) are secondary to malnutrition.
Other possible symptoms include behavioural changes, muscle
cramps, tingling numbness in the limbs, mouth ulcers, dermatitis,
tooth discolouration and missed menstrual periods.
Diagnosis  
Coeliac disease can be difficult to diagnose
because symptoms are similar to those of other diseases,
including irritable bowel syndrome, Crohn's disease, ulcerative
colitis, diverticulosis, intestinal infections, chronic
fatigue syndrome and depression. Diagnosis is suspected
on the basis of the symptoms and signs, enhanced by laboratory
and x-ray studies. Endoscopy may be performed whereby the
Gastroenterologist introduces a flexible tube carrying a
tiny camera through the mouth and stomach into the small
intestine. This allows a sample of intestinal tissue (a
biopsy) to be obtained for examination under the microscope
and checked for damage to the intestinal lining and villi.
Biopsy of the small intestine is the best way to diagnose
coeliac disease. The diagnosis can then be confirmed by
clinical and microscopic improvement on a gluten-free diet.
Antibodies are produced by the immune system
in response to substances that the body perceives to be
threatening. Coeliac disease may be diagnosed through the
presence of antibodies to gluten in the blood. These antibodies
are antigliadin, anti-reticulin, anti-endomysium and TTG(tissue
trans-glutaminase). This is a non-invasive way to screen
for coeliac disease in 'at risk' patients (eg. those with
coeliac disease-suffering family members). Positive blood
tests should be followed-up with an endoscopy, biopsy and
histological analysis.
Treatment
The standard treatment for coeliac disease
is to remove all gluten-containing foods from the diet.
For many patients, this is enough to control symptoms, heal
existing intestinal damage (the villi regain function) and
prevent further damage. Improvements can begin within days
of starting the diet and the small intestine is often completely
healed within 3 to 6 months.
The gluten-free diet is a lifetime requirement.
Eating any gluten, no matter how small an amount, can damage
the intestine. This is true for anyone with the disease,
including patients without noticeable symptoms. Depending
on a person's age at diagnosis and the severity of the disease,
some problems, such as delayed growth and tooth discoloration,
may not improve.
A proportion of patients with coeliac disease
do not improve on the gluten-free diet and need to receive
nutritional supplements. Supplementary vitamins, minerals,
especially iron, are given according to the deficiency.
While mild cases of coeliac disease may not require any
supplementation, severe cases require comprehensive intravenous
replacement. Drug treatments are being evaluated for unresponsive
coeliac disease. These patients may need to be monitored
for signs of complications of the disease, which include
lymphoma, osteoporosis and seizures among others.
Back Home
|
