What is coeliac disease?
Even tiny amounts of gluten can cause symptoms. If the individual does not eliminate gluten from their diet, the intestinal villi will flatten together or even disappear and the lining of the small intestine will no longer be able to absorb enough nutrients, ultimately resulting in malnutrition.
Symptoms of coeliac disease
The symptoms of coeliac disease can vary widely. In many cases – but not always – the disorder is marked by gastro-intestinal symptoms:
- Diarrhoea
- Abdominal bloating or distension
- Abdominal pain
- Nausea
- Vomiting
General symptoms may also be present in individuals with coeliac disease:
- Loss of weight and energy
- Loss of appetite
- Iron deficiency with anaemia
- Osteoporosis
- Fertility disorders or miscarriage
- Vitamin and/or mineral deficiencies
In children, coeliac disease develops at an early age, often after weaning when switching from breast milk to gluten-containing food. If the disease goes undetected, there is a risk of growth and developmental disorders. Children with coeliac disease usually have a slight build, are weepy and very sensitive.
Types of coeliac disease
Coeliac disease may take a classic, symptomatic or subclinical form. All of these forms are associated with damage to the small bowel mucosa. In addition, there is potential coeliac disease, which is usually discovered coincidentally and shows normal bowel mucosa on biopsy.
Diagnosing coeliac disease
Coeliac disease can occur in people of all ages. When coeliac disease is suspected, the first step involves testing the individual’s blood. To this end, the immunoglobulin A tissue transglutaminase (IgA tTG) antibodies, as well as the total IgA are determined. Determination of the anti-endomysium antibodies (EMA) is just as reliable for diagnosis, but is less widely used. If antibodies are detected, a biopsy of the small bowel is then taken for confirmation.
Since coeliac disease is often hereditary, first-degree relatives (parents, siblings, children) should also be tested for coeliac disease, even if they do not have any symptoms.
It is important not to start following a gluten free diet before you see your doctor. If you do so, the antibodies will not longer be able to be detected in the blood, which prevents the disorder from being diagnosed.
Treating coeliac disease
If the diagnosis of coeliac disease has been confirmed, your specialist will advise you to begin following the gluten free diet immediately. The only effective treatment for coeliac disease is complete lifelong avoidance of all foods containing gluten. Changing over to the gluten free diet alone usually leads to rapid improvement. Many people with coeliac disease are symptom-free very soon after they switch to a gluten free diet. However, it can take several months until the small bowel mucosa has completely regenerated.