Coeliac Disease

What is Coeliac Disease?

Coeliac disease is an immune condition involving multiple organs but is primarily centred on the gut. It results from an allergy to Gliadin, a protein in wheat.

It is important not to confuse Coeliac disease with gluten intolerance, known as NCGS or non-coeliac gluten sensitivity.

SYMPTOMS

Symptoms can vary widely, based on the degree of reaction of the body to gluten. These be very mild, and start with diarrhoea, abdominal cramps and bloating. At the extreme end of the spectrum, there can be anaemia (low red blood cell count), joint, skin and even immune system involvement.

WHEN to See a Doctor

If you have the symptoms listed above and a family member or history of Coeliac disease, then you should seek medical attention. Coeliac disease is a significant condition with long term health implications. 

CAUSES

It is an immune mediated disorder, triggered by the consumption of gluten. A protein known as gliadin, which is found in wheat, is known to trigger an allergic reaction in susceptible individuals. Coeliac disease is not acquired but inherited.

RISK FACTORS

It is a genetic disorder. There are two genes for coeliac disease. These genes are called human leukocyte antigen (HLA) DQ2 and DQ8. Many people who have coeliac disease have at least one of these genes. But it is important to remember that for the disease to manifest, there needs to be a trigger, which in this case is gluten. 

DIAGNOSIS

The diagnosis of coeliac disease can be made through a blood test or biopsy. 

After a suitable period of gluten challenge, where the patient has been consuming gluten, a blood test is done for an antibody known as Tissue Transglutaminase (TTG)-IgA and Deaminated Gliadin Peptide (DGP). An alternative way would be biopsies of the first segment of the small bowel, known as the duodenum, which would accurately confirm if there is inflammation from coeliac, and has the added advantage of grading the degree of severity – through a system known as the Marsh score.

TREATMENT

Treatment is simple and involves the complete avoidance of wheat containing foods. However, this is easier said than done and often involves strict diligence and the involvement of a dietitian. With the current technology, many portable devices are now available to help patients test if particular foods contain gluten before consumption.