Coeliac disease
Coeliac disease (CD) is an autoimmune disorder triggered by gluten, a protein found in wheat, rye, and barley. Genetic predispositions cause individuals with coeliac disease to react adversely to gluten, leading to an immune-mediated inflammatory response in the small intestine. This inflammation results in damage to the intestinal villi, the tiny, finger-like projections lining the small bowel.
The compromised villi impair the intestine's ability to absorb nutrients effectively, which can manifest in a broad spectrum of symptoms and indicators of malabsorption. The diverse range of symptoms associated with coeliac disease reflects the critical role of the small intestine in nutrient uptake and overall health. Addressing this condition is essential for maintaining the nutritional well-being and quality of life of affected individuals
Symptoms of coeliac disease
The classic manifestations of coeliac disease include diarrhea, weight loss, and, in children, failure to thrive. However, contemporary presentations of the disease frequently involve only mild gastrointestinal symptoms, such as abdominal pain, loose stools, or bloating.
Often accompanying coeliac disease is lactose intolerance, stemming from the small intestine's compromised ability to produce lactase, the enzyme essential for lactose digestion, due to the inflammation and damage caused by gluten exposure.
Moreover, the malabsorption resulting from damaged intestinal villi can lead to deficiencies in nutrients and vitamins. This may precipitate a range of secondary health issues, including anaemia, osteoporosis, persistent fatigue, and an overall sense of malaise. These indirect symptoms underscore the systemic impact of coeliac disease beyond the gastrointestinal tract, highlighting the importance of comprehensive management and care.
Dermatitis herpetiformis
Dermatitis herpetiformis (DH), often referred to as "the coeliac disease of the skin," is a condition characterized by an extremely itchy rash. This rash typically shows up on the rounded parts of the body, like the knees, elbows, scalp, and buttocks. Individuals with DH often have damage to their small intestine's villi, similar to that seen in coeliac disease. It's not uncommon for coeliac disease and DH to occur within the same families.
To diagnose DH, doctors usually perform a skin biopsy and often a biopsy of the small bowel as well. It's important not to switch to a gluten-free diet before these biopsies are done because it can affect the accuracy of the test results. The main treatment for DH is following a gluten-free diet, which can gradually eliminate the skin symptoms. In some cases, additional medication might be prescribed to help manage the condition.
Diagnosis
Coeliac disease can be screened through various blood tests that look for specific antibodies, mainly the transglutaminase and endomysium antibody tests. Sometimes, to confirm the diagnosis, a biopsy of the small intestine might be needed. This is done to look for a specific kind of damage known as villous atrophy, where the tiny, finger-like projections in the intestine, which help absorb nutrients, are flattened.
It’s crucial not to start a gluten-free diet before having the small bowel biopsy. The reason is straightforward: if you avoid gluten for a significant period before the biopsy, your intestines might start to heal, and the changes typical of coeliac disease could disappear. This makes it hard to get an accurate diagnosis since the healed villi won't show the signs needed to confirm the condition.
Treatment
The sole treatment for coeliac disease is a strict gluten-free diet. This means avoiding all foods that contain wheat, rye, and barley. However, you can include gluten-free oats in your diet, which are oats processed in a way that prevents contamination with gluten.
Starting a gluten-free diet helps the small bowel's villi to heal. Once they recover, your bowel starts working properly again, and your body can absorb nutrients as it should.
But remember, this doesn't mean coeliac disease is completely gone. To keep your digestive system healthy and prevent symptoms from returning, you'll need to stick to the gluten-free diet for life.