Coeliac disease, a digestive condition that's more widespread than commonly believed, often remains misunderstood. In this blog, our Coeliac Specialist Dietitian, Cristian Costas, delves into crucial facts about this condition. By building awareness and understanding, we can help those with coeliac disease be diagnosed and treated sooner, enabling them to lead healthier and happier lives.
Understanding Coeliac Disease
This chronic multi-system autoimmune disease is triggered by the consumption of gluten, a protein present in wheat, barley, and rye (1). When individuals with coeliac disease eat gluten, their immune system erroneously attacks the small intestine, resulting in inflammation and internal damage. Consequently, overall nutrient absorption can be compromised. If the persistent intestinal inflammation is left untreated without eliminating gluten from the diet, it can lead to various other health complications.
Prevalence
Coeliac disease is not a rare condition. It's estimated that around 1% of the global population lives with it. In the UK, however, roughly 64% of individuals remain undiagnosed (2), meaning that many people have coeliac disease without knowing it. Genetic factors also play a role in development of coeliac disease; this is why first-degree relatives of coeliac disease patients have a 10% increased likelihood of developing the condition (1).
Symptoms
Undiagnosed or untreated coeliac disease can manifest an array of symptoms that vary from person to person. Interestingly, around 20% of individuals with coeliac disease may not experience any noticeable symptoms at all.
Common symptoms can include:
Digestive issues: abdominal pain, bloating, flatulence, diarrhoea, constipation, nausea, and vomiting.
Unintentional weight loss
Severe fatigue and weakness
Deficiencies in vitamins and minerals, notably iron, B12, and folate, among others.
Neurological symptoms: headaches, brain fog, numbness, or tingling sensations.
Dermatological problems: an itchy skin rash called dermatitis herpetiformis, alongside other skin concerns.
Some individuals may also experience mouth ulcers and dental enamel defects.
Osteoporosis: fragile and brittle bones
Fertility challenges: recurrent miscarriages and difficulty conceiving.
Diagnosis
For adults, diagnosing coeliac disease usually entails a multi-step process, beginning with a comprehensive medical history and examination. If coeliac disease is suspected, blood tests are conducted to detect specific antibodies linked to the condition. The primary blood test commonly used is Immunoglobulin A Tissue Transglutaminase (TTG). Elevated levels in the blood test indicate a potential case of coeliac disease. To confirm the diagnosis, an endoscopy (or camera examination) involving taking biopsies of the small intestine is usually performed (1). During the biopsy, tiny tissue samples are extracted from the small intestine and analysed under a microscope to confirm intestinal damage.
Treatment
The sole effective treatment for coeliac disease is a lifelong strict gluten-free diet. This involves eliminating all sources of gluten from the diet, including wheat, barley, rye, and their derivatives. This is more difficult than it may seem, as even minimal gluten ingestion can damage the small intestine. It's vital to steer clear of gluten cross-contamination, which entails avoiding scenarios where gluten can come into contact with gluten-free food i.e. during cooking, production, or food preparation. Additionally, while most individuals can tolerate gluten-free oats, some may need to avoid them entirely. Seeking guidance, instruction, and support from a dietitian with specialised expertise in coeliac disease can therefore be hugely beneficial. It can aid understanding of how to implement the gluten-free diet with minimal restrictions, while ensuring the diet remains balanced.
Monitoring
Once diagnosed with coeliac disease, consistent monitoring by both a gastroenterologist and dietitian is vital. They can conduct appropriate follow-up tests and offer accurate dietary advice. Individuals living with coeliac disease should also undergo annual monitoring, in line with UK guidelines, including annual blood tests (1).
Conclusion
Coeliac disease is a serious autoimmune condition impacting many individuals globally. Gaining an accurate understanding of this disease is pivotal for early diagnosis and proper management. If you suspect you or someone you know has coeliac disease, seeking appropriate medical advice and undergoing thorough testing is key for a healthier life. If you require assistance and support, feel free to reach out to us. Our expert Coeliac Disease Dietitian, Cristian Costas, and our Gastroenterologist, Dr. Sami, collaborate to ensure the best outcomes for you.
References
1. Ludvigsson JF, Bai JC, Biagi F, et al. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut, 2014; 63: 1210-1228
2. Source data from Nartey Y, Crooks CJ, Card TR et al. Incidence and prevalence of coeliac disease across the United Kingdom; University of Nottingham December 2021 (Coeliac UK internal report, as yet unpublished)