Causes, Symptoms, Diagnosis, Diet & Treatment
What is coeliac disease? Also known as celiac, this is a condition where the lining of the gut wall is destroyed due to sensitivity to a protein found in gluten containing foods leading to chronic abdominal pain, weight loss, being tired all the time, plus or minus diarrhoea, failure to grow properly in children (short stature), iron deficiency anaemia, skin rash and more.
Coeliac disease, (spelt in North America as celiac disease) is not a food allergy or food intolerance. It is an immunological reaction or sensitivity to gluten leading to inflammation of the bowel wall (mainly the small intestines) with resultant malabsoprtion.
Gluten is a complex protein made up of two main components - gliadins and glutenins, and they are found in food stuffs made with wheat, like bread, some breakfast cereals and cakes. Similar proteins are also found in products made from barley and rye (hordeins in barley and secalins in rye respectively).
The gliadins are usually broken down by intestinal enzymes into amino acids and absorbed from our gut. In some people, the digestion of gliadins is impossible, and instead, its component slips through the wall of the gut and cause an immune reaction.
The body sees the undigested component of gluten as foreign and releases chemicals that aim to destroy the gluten protein, but this chemical end up destroying the linings of the wall of the intestine that aids absorption of digested food.
This result in very poor absorption of ingested food, particularly iron, calcium, vitamins and other essential minerals needed for proper growth and development.
No wonder some call it gluten sensitivity. Wheat, barley, and rye containing food are rich in gluten, while food stuff made from cassava, rice, maize, oats and yam are gluten free. This condition is reversible if a gluten free diet is started.
Who Can Develop Coeliac Disease?
- Coeliac disease affects about 1 in every 100 to 300 persons in the United Kingdom
- It is a disease of the Western world – Europe, North America, now reported also in South America, Australia, New Zealand, but almost unknown in people of African descent
- Because of diagnostic difficulties, only about 10% of those who suffer with this disease are diagnosed by doctors
- Many persons who are labelled as having “irritable bowel syndrome” might actually be suffering from coeliac. Thus it is very important to exclude a diagnosis of celiac before anyone is labelled as having ibs
- Women are 3 times more likely to suffer with coeliac disease, than their male counterpart
- There is increased chance of having celiac disease, if a family member have it (up to 10 times more)
- Breastfeed children are less likely to develop coeliac
- Babies who suffer with recurrent cold from rota virus infection are more likely to have coeliac disease
- A negative test for the presence of HLA-DQ2 or HLA-DQ8 genetic component in an individual rules out a likelihood of someone having celiac disease now or even developing it in the future
- While coeliac can be developed at any age, especially in childhood, the peak time of diagnosing people with this disease is around age 4 and 40
Symptoms of Coeliac
Most people with coeliac disease just tag along and do not develop any clear symptoms. The main symptoms of coeliac disease however include:
- Weakness and being tired all the time
- Bloating and dull to cramping abdominal pain for several months or years, worse on eating food stuff like bread or those made from wheat, rye or barley
- Unexplained weight loss or failure to grow properly in children
- Loose stools or diarrhoea for several months or years
- Unexplained anaemia (iron deficiency anaemia)
- Mouth ulcers, feeling nauseated most times, and even vomiting
- Excessive Trapped wind
- Presence of dermatitis herpetiformis
If you suffer with any combination of the above symptoms, then it will be a good idea to be tested for coeliac.
Diagnosis of Coeliac
The diagnosis of celiac disease is made by identifying any of the above symptoms and then carrying out tests for celiac disease.
A simple way of testing for the possible presence of coeliac disease is to stop eating gluten containing food for about 6 weeks. If you take such food out of your diet and notice that most of your symptoms disappear, then a diagnosis of coeliac disease is very likely if symptoms reoccur on restarting a gluten diet. It is now time to go for specific blood test for celiac.
For a celiac test to be significant, you need to be on a gluten diet for at least 6 weeks. The tests for this condition will include:
- Coeliac Serology test of IgA Transglutaminase (tTGA). This test is only significant where the suffers is proven not to be IgA deficient.
- IgA Endomysal Antibody Test (EMA) - very important if tTGA comes back negative.
- Intestinal biopsy if symptoms are strongly indicative, and serological testing remains negative.
Other tests that may be necessary in investigation of celiac disease include:
- Full blood count (or Complete Blood Count) to establish or exclude anaemia. This might also reveal raised platelet count if there is associated hyposplenism, indicating that the spleen is shrinking. Blood film may show Howell-Jolly Bodies and Target Cells
- Serum Iron and Ferritin Levels
- Vitamin B12 and Folate levels
- Liver Function Test
- Electrolyte and Urea Testing
- Clotting and Coagulation Testing
- Serum Calcium & Vitamin D levels
- Thyroid Function Test to exclude reduced thyroid levels as cause of symptoms
Treatment of Coeliac Disease
Treatment of coeliac invlove complete avoidance of gluten. Once diagnosed, the sufferer must start instituting a gluten-free diet. As an adjunct to treament, there is often the need too, to replace deficiency of iron, vitamin B12 and folic in meals, as well as treament for osteoporosis - calcium and vitamin D in those with bone disease from coeliac.
This means they must avoid foods made from wheat, rye and barley. Many food sold in the market today has gluetn. Always read the label.
Gluten free diets will include bread, passeries and other food items made from cassava, rice, maize, corn, yam, plantain, and oat. Oat contains a gluten like protein called avenins. In its pure state, this should not cause problem. A few individuals also develop coeliac-like problem from the protein in oat. It is best avoided if that is noticed to be the case.
You can get a list of gluten free meal recipes from Coeliac UK.
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