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Coeliac Disease

About Coeliac Disease

Coeliac disease is a chronic disease of the digestive tract that interferes with the digestion and absorption of food nutrients. Affected people cannot tolerate gliadin, the alcohol-soluble fraction of gluten, a protein commonly found in wheat, rye, and barley - when this is ingested the lining of the intestines is damaged by an immunologically mediated inflammatory response, resulting in poor digestion and malabsorption. Most patients with coeliac disease tolerate oats. It has a strong hereditary component with approximately 10% of first-degree relatives similarly affected.

Estimates suggest that approximately 1% of the population is affected and the condition is under-diagnosed in most affected people, with symptoms being wrongly attributed to more common conditions such as irritable bowel syndrome. It is prevalent in European countries with temperate climates, particularly Ireland and Finland and in places to which Europeans have emigrated, notably North America and Australia. It might become apparent in infants when gluten ingestion begins and symptoms might persist throughout childhood if untreated but usually diminish in adolescence, often reappearing in early adulthood. Approximately 20% of patients with coeliac disease are older than 60 years. Affected adolescents frequently present with extra-intestinal manifestations, including short stature, behavioural problems, fatigue, and skin problems.

Symptoms can include one or more of the following: chronic diarrhea, abdominal bloating or cramps, flatulence, weight loss, fatigue and anaemia. It is a significant and often debilitating disease affecting multiple organ systems. Patients with the disease are at increased risk for complications, such as cancer and lymphoma of the intestinal tract. Untreated pregnant women are at risk of miscarriage and of having a baby with a congenital malformation. Short stature often results when the disease prevents nutrient absorption during the childhood years when it is critical to growth and development. The diagnosis is often not established until middle age or old age.

The diagnosis of coeliac disease in patients suspected of having the disease should be confirmed by a combination of special blood tests and biopsy of the duodenum which can be achieved relatively simply by gastroscopy. The most important aspect of treatment is dietary and complete avoidance of gluten-containing foods is essential - for practical purposes this means all wheat-based products.