Coeliac Disease

What is Coeliac Disease?

Coeliac disease is an autoimmune disorder that’s triggered when you eat gluten. It’s also known as coeliac sprue, nontropical sprue, or gluten-sensitive enteropathy.

Gluten is a protein in wheat, barley, rye, and other grains. It’s what makes dough elastic and gives bread its chewy texture. When someone with coeliac disease eats something with gluten, their body overreacts to the protein and damages their villi, small finger-like projections found along the wall of their small intestine.

When your villi are injured, your small intestine can’t properly absorb nutrients from food. Eventually, this can lead to malnourishment, as well as loss of bone density, miscarriage, infertility or even neurological diseases or certain cancers.

If your coeliac disease isn’t better after at least a year without gluten, it’s called refractory or nonresponsive coeliac disease.

Coeliac disease isn’t the same thing as gluten intolerance or gluten sensitivity. People with gluten intolerance may have some of the same symptoms and may want to avoid gluten. But they don’t show an immune response or damage to the small intestine.

 

Symptoms

If you have coeliac disease and accidentally eat something with gluten in it, you may have symptoms including:

• Abdominal pain
• Anemia
• Bloating or a feeling of fullness
• Bone or joint pain
• Constipation
• Diarrhea
• Gas
• Heartburn
• Itchy, blistery rash (doctors call this dermatitis herpetiformis)
• Headaches or fatigue
• Mouth ulcers
• Nausea
• Nervous system injury, including numb or tingling hands or feet, balance problems, or changes in awareness
• Poop that’s pale, smells especially bad, or floats (steatorrhea)
• Weight loss

 

Screening

Screening for coeliac disease involves a two stage process:

• A blood test to help identify people who may have coeliac disease
• A gut biopsy to confirm the diagnosis

 

Blood Test

Your GP will take a blood sample and test it for certain antibodies that are usually present in the bloodstream of people with coeliac disease. You should not be avoiding gluten from your diet when the blood test is done as this could lead to an inaccurate result.

However, it is sometimes possible to have coeliac disease and not have these antibodies in your blood. If coeliac disease antibodies are found in your blood, your GP will refer you for a biopsy of your gut.

Gut Biopsy

A gut biopsy is carried out in hospital, usually by a gastroenterologist (a specialist in treating conditions of the stomach and intestines). A gut biopsy can help confirm a diagnosis of coeliac disease.

If you need to have a gut biopsy, an endoscope (a thin, flexible tube with a light and a tiny cutting tool on the end) will be inserted into your mouth and gently passed down to your small intestine. Before the procedure, you will be given a local anaesthetic and a sedative to numb your throat and help you relax.

The gastroenterologist will use the cutting tool at the end of the endoscope to cut away a small piece of tissue from your small intestine. The sample will then be examined in a laboratory for signs of coeliac disease.

 

Tests After Diagnosis

If you are diagnosed with coeliac disease, you may also have a number of other tests to assess how the condition has affected you so far.

You may have further blood tests to check the levels of iron and other vitamins and minerals in your bloodstream. This will help determine whether coeliac disease has led to you developing anaemia (a lack of iron in your blood) due to poor digestion.

If you appear to have dermatitis herpetiformis (an itchy rash that is also caused by gluten intolerance), you may have a skin biopsy to confirm it.

This will be carried out in a similar way to a gut biopsy.

A small skin sample will be taken from an area that is unaffected by the rash so that it can later be examined.

In some cases of coeliac disease, a DEXA scan may also be recommended. A DEXA scan is a type of X-ray that measures bone density. It may be necessary if your GP thinks that your condition may have started to damage your bones. In coeliac disease, a lack of nutrients, caused by poor digestion, can make your bones weak and brittle (osteoporosis).