Coeliac UK

Coeliac Disease

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Coeliac disease is an autoimmune disorder that primarily affects the small intestine. It occurs in genetically predisposed people of all ages from middle infancy onward. Symptoms include chronic diarrhea, abdominal distention, malabsorption, loss of appetite, and among children, failure to grow normally.

Pathophysiology

Coeliac disease is caused by a reaction to gliadin, a prolamin (gluten protein) found in wheat, and similar proteins found in the crops of the Triticeae tribe, which includes other common grains such as barley and rye. Upon exposure to gliadin, the enzyme tissue transglutaminase modifies the protein, and the immune system cross-reacts with the small-bowel tissue, causing an inflammatory reaction. This leads to a truncating of the villi lining the small intestine (villous atrophy), which interferes with the absorption of nutrients.

Diagnosis

The diagnosis of coeliac disease is typically confirmed by serology and biopsy. Serological tests look for specific antibodies, such as anti-tissue transglutaminase (tTG) and anti-endomysial antibodies (EMA). A definitive diagnosis is made through a biopsy of the small intestine, which shows villous atrophy and crypt hyperplasia.

Treatment

The only effective treatment for coeliac disease is a lifelong gluten-free diet. This involves the avoidance of foods containing wheat, barley, rye, and derivatives of these grains. Adherence to a gluten-free diet allows the intestinal mucosa to heal, alleviates symptoms, and reduces the risk of complications.

Complications

If untreated, coeliac disease can lead to several complications, including osteoporosis, infertility, neurological conditions, and an increased risk of certain types of cancer, such as intestinal lymphoma.

Epidemiology

Coeliac disease affects approximately 1% of the population worldwide, although many cases remain undiagnosed. It is more common in individuals of European descent and is less common in people of Asian and African descent.

Related pages

• Gluten-free diet
• Autoimmune disease
• Malabsorption
• Small intestine