Coeliac Disease: All you need to know
What is Coeliac Disease?
Coeliac Disease, also known as Celiac Disease, is a genetically determined, autoimmune condition that causes inflammation within the gut following exposure to gluten in the diet. As a genetic condition, it can run in families and you have about a 10-15% chance of having coeliac disease if another first degree relative (such as a parent or a sibling) has the condition.
It is fairly common, up to 1 in 100 people in the UK suffer from coeliac disease although as many as 90% of sufferers are thought not to have been diagnosed. Rates of coeliac disease seem to have been rising over the last few decades although it is not clear if this is due to more tests for coeliac disease being carried out, or a genuine increase in the number of people with the condition.
What are the Symptoms?
Symptoms from coeliac disease can be very variable and it is this variability that sometimes causes the diagnosis to be overlooked. Some people will suffer no symptoms at all, others may have very mild symptoms that are often attributed to ‘Irritable Bowel Syndrome’ (IBS). In order to increase the pickup rate of coeliac disease, guidelines issued by the National Institute for Health and Care Excellence (NICE) in the UK suggest blood tests for the condition under a wide range of circumstances.
This includes testing people who are suffering with unexplained abdominal symptoms such as:
- Bloating
- Pain
- Diarrhoea or Constipation
Essentially symptoms that might otherwise be described as IBS. It should also be tested for when deficiencies in iron, vitamin B12 or folic acid are detected because the inflammation in the gut typical of coeliac diseases prevents the proper absorption of these micronutrients. Associated with this might be prolonged fatigue, weight loss, or severe and persistent mouth ulcers. All of these symptoms should also prompt consideration of coeliac disease. For the same reason, coeliac disease should be tested for in children who are not growing or gaining weight as quickly as expected.
Some people are higher risk of developing coeliac disease because they suffer with other conditions associated with coeliac disease. These include Type 1 diabetics, people with an autoimmune thyroid disease, and people who suffer with Down’s syndrome or Turner’s syndrome.
What happens if left untreated?
Left untreated, coeliac disease can progress to cause a lot of different problems, mainly due to the poor absorption of micronutrients.
These can include neurological problems such as:
- Neuropathy
- Ataxia
- Depression
- Dementia
It can also include metabolic bone disease (such as osteoporosis or osteomalacia), and dental enamel defects.
Fortunately, once it is recognised, coeliac disease is easy to treat and so these complications are extremely rare. The focus of treatment is strict avoidance of gluten which prevents the inflammation in the gut and all the subsequent problems that can lead on from that. With the greater availability of gluten free products, and a public awareness which means that many restaurants now offer gluten free dishes, avoiding gluten is now much easier than it was in the past.
How to diagnose Coeliac Disease
A diagnosis of coeliac disease is actually fairly straightforward as long as someone thinks about it. The condition can generally be excluded with a blood test. There are a number of different blood tests that can be used, each of which check for autoantibodies (these are the components of the immune system that lead to inflammation in the gut). Perhaps the most commonly used is known as tTG-IgA. A positive result is suggestive of coeliac disease whilst a negative result helps to rule it out. Alongside this test, total IgA levels are usually checked because a small number of people have naturally low IgA levels – in these people a different test is recommended.
It is really important to note that the test is only accurate in people who are still eating gluten. Once gluten is cut out from your diet then the test becomes negative and this is actually one of the ways that the disease is monitored. Before you undertake the test, you should make sure that you have been eating gluten for at least six weeks. The amount of gluten per day should be about that contained in two slices of bread.
Traditionally, a positive blood test has been followed up by an endoscopy to take a biopsy from the lining of the gut to confirm the diagnosis. However, there is now a trend towards doing fewer endoscopies as the combination of symptoms, a blood test, and a response to a gluten free diet is often considered sufficient to confirm the diagnosis.
It is also worth mentioning that some people are sensitive to gluten without having coeliac disease. This is known as non-coeliac gluten sensitivity. These people will usually have IBS type symptoms and a negative coeliac blood test. Their symptoms do however improve if they cut gluten out from their diet. The only real way to diagnose this condition is to undertake a trial period off gluten and then re-introduce gluten at a later stage to see of symptoms return.
In summary...
Coeliac disease is a common condition that is underdiagnosed. Symptoms range from none at all, to fairly severe and debilitating symptoms that may be gastroenterological, metabolic or neurological. However, it is straightforward to manage, and the management starts with diagnosis.
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