About
Coeliac disease is an autoimmune condition triggered by the consumption of gluten, a protein found in wheat, barley and rye. It affects 1 in 100 people worldwide and can cause stunted growth, exhaustion, bloating, diarrhoea, abdominal pain, weight loss and anaemia. For individuals suffering from the condition, it is important to eat a gluten-free diet to reduce their symptoms. If properly managed, people with coeliac disease can live a normal life. Treatment for Coeliac disease includes a strict gluten-free diet, vitamin and mineral supplements and regular check-ups with a doctor.
Symptoms
The symptoms of Coeliac disease vary widely, but some of the most common ones include digestive issues such as bloating, nausea, diarrhea, abdominal pain, and weight loss. Other non-digestive symptoms include fatigue, anemia, bone or joint pain, skin rash (dermatitis herpetiformis), and mouth ulcers. Neurological symptoms such as depression, anxiety, and tingling in the hands and feet can also occur.
Causes
The exact cause of Coeliac disease is unknown, but it is thought to be triggered by a combination of genetic and environmental factors. It is believed to involve an autoimmune reaction to gliadin, a protein found in wheat and other grains. People with certain genetic variations, specifically in certain HLA (human leukocyte antigen) genes, are more prone to developing the disease if exposed to gluten. Exposure to a virus or a bacterial infection may also play a role in triggering the response.
Risk factors
Risk factors for Coeliac disease include having a first-degree relative (parent, sibling, or child) with the condition, having another autoimmune disorder, having had intestinal damage from an infection, having Down Syndrome, and being a member of an ethnic group that is at higher risk of developing the disease (e.g., European Caucasians). Other potential risk factors include being born prematurely, having had repeated bouts of gastroenteritis, and having a history of infertility. In addition, a gene known as HLA-DQ2 or HLA-DQ8 may be associated with an increased risk of developing Coeliac disease.
Diagnosis
Coeliac disease is usually diagnosed by a combination of medical history and laboratory testing. The first step is to talk to your doctor to discuss your symptoms and medical history. Your doctor may then order a blood test to measure antibodies related to celiac disease. If the results of the blood test are positive, your doctor may order a biopsy of your small intestine to confirm the diagnosis. This can require an endoscopy and potentially a small surgical procedure. Additionally, genetic testing may be done if your doctor believes you may have inherited a genetic predisposition to the disease.
Sub-types
Coeliac disease is an autoimmune disorder that is triggered by the consumption of gluten, a type of protein found in wheat, barley, and rye. It’s estimated that 1 in 100 people have coeliac disease, but most are undiagnosed.
The most common subtype of coeliac disease is Marsh-type 1, which is characterized by villous atrophy in the small intestine, where proteins from food are absorbed. Marsh-type 1 is the most common form of coeliac disease, and it is caused by an immunological response to gluten.
Marsh-type 2 is a subtype of coeliac disease that is characterized by villous blunting and crypt hyperplasia. It is much rarer than Marsh-type 1, but it is still relatively common. Marsh-type 2 tends to affect older adults, and it is not caused by an immune reaction to gluten, but by an underlying genetic abnormality.
Marsh-type 3 is the rarest and most severe form of coeliac disease. It is characterized by severe villous atrophy, crypt hyperplasia, and inflammation of the small intestine. Marsh-type 3 is usually caused by an autoimmune reaction to gluten and can lead to life-threatening complications if not treated appropriately.
Collagenous Sprue is a rare form of coeliac disease that is characterized by thickened collagen fibres in the small intestine, which interfere with the absorption of nutrients. Collagenous Sprue is more common in middle-aged women and is usually caused by an autoimmune reaction to gluten.
Finally, there is Refractory Coeliac Disease, which is a form of coeliac disease that does not respond to a gluten-free diet. Refractory Coeliac Disease is usually caused by an underlying genetic abnormality, and the treatment can range from a strict gluten-free diet to steroids or even chemotherapy.
Treatments
The main treatment option for Coeliac disease is to make sure that gluten is taken out of the diet. This means avoiding foods such as bread, pasta, cakes, and biscuits that have wheat, rye, spelt or barley in them, and eating gluten-free substitutes instead. Following a gluten-free diet should stop the symptoms of Coeliac disease and prevent further health problems.
In some cases, medical advice may be needed to help manage the disease and track its progress. This may include regular follow-up appointments with a doctor and dietitian for nutritional advice and support. Medications, such as enzyme supplements or immunomodulators, may be prescribed to help manage specific symptoms. In severe cases, surgery may be required.
Prevention
The best way to reduce the risk of Coeliac disease is to maintain a healthy diet and lifestyle. Specifically, it is important to consume a balanced and nutritious diet with plenty of fruits and vegetables, whole grains, lean proteins, and healthy fats. Additionally, regular exercise, avoiding smoking, and maintaining a healthy weight can help reduce the risk of developing the disease. Additionally, if someone has a family history of Coeliac disease, it is recommended that they get screened and tested regularly.
Gender differences?
Yes, there are gender-specific differences in the presentation and management of Coeliac disease. Studies have shown that women are more likely to be diagnosed with Coeliac disease than men, and may present with more diverse symptoms than men. Women also tend to have higher levels of antibodies, and this has been attributed to hormonal and dietary differences. Furthermore, women have been found to have lower rates of adherence to a gluten free diet than men, likely due to social, cultural, and logistical factors. Lastly, women may be at higher risk for developing certain complications of Coeliac disease, such as anemia, osteoporosis, and infertility. Therefore, it is important for healthcare professionals to consider gender-specific differences when diagnosing and managing Coeliac disease.
Nutrition
Nutrition plays an essential role in the management of Coeliac disease. A strict gluten-free diet is necessary for the effective management of Coeliac disease and the associated symptoms. Consuming a variety of foods from all food groups is essential for overall health and wellness. Nutrient-dense gluten-free foods such as whole grains, fruits, vegetables, nuts, seeds, and legumes should be included in the diet in order to ensure adequate intake of dietary fibre, vitamins, and minerals. Additionally, people with Coeliac disease should monitor their intakes of essential nutrients like iron, calcium, zinc, and vitamin D, as malabsorption of these nutrients is common in Coeliac disease. Supplementation and/or fortification with these nutrients may be necessary if deficiencies are present. Finally, it is important for people with Coeliac disease to consult a dietitian or qualified health professional to ensure proper nutrition and to help navigate the gluten-free diet.
Physical Activity
Physical activity can help to manage and improve Coeliac disease. Regular physical activity, such as walking, jogging, biking or swimming, can help reduce the symptoms of Coeliac disease, including fatigue and abdominal pain. Physical activity can also help to reduce the risk of other health problems, such as obesity and diabetes, which are more common in people with Coeliac disease. Additionally, physical activity helps to reduce stress and improve mental health, which can be beneficial for managing the symptoms of Coeliac disease.