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Coeliac disease
Coeliac disease (Commonwealth English) or celiac disease (American English) is a chronic autoimmune disease, mainly affecting the small intestine, and is caused by the consumption of gluten. Coeliac disease causes a wide range of symptoms and complications that can affect multiple organs outside of the gastrointestinal tract.
The symptoms of coeliac disease can be divided into two subtypes, classic and non-classic. The classic form of the disease can affect any age group, but is usually diagnosed in early childhood and causes symptoms of malabsorption such as weight loss, diarrhoea, and stunted growth. Non-classic coeliac disease is more commonly seen in adults and is characterized by vague abdominal symptoms and complications in organs outside of the gastrointestinal tract, such as bone disease, anemia, and other consequences of nutritional deficiencies.
Coeliac disease is caused by an abnormal immune system response to gluten, found in wheat and other grains such as barley and rye. When an individual with a genetic predisposition to coeliac disease consumes gluten, it triggers an inflammatory response in the small intestine, damaging the intestinal lining, leading to malabsorption. The development of coeliac disease is believed to be influenced by other environmental factors, such as infections.
Diagnosis is typically made by a combination of blood antibody tests and intestinal biopsies, helped by specific genetic testing. Diagnosis is not always straightforward. About 10% of the time, the autoantibodies in the blood are negative, and many people have only minor intestinal changes with normal villi. People may have severe symptoms and they may be investigated for years before a diagnosis is achieved. As a result of screening, the diagnosis is increasingly being made in people who have no symptoms. Evidence regarding the effects of screening, however, is as of 2017, insufficient to determine its usefulness. While the disease is caused by a permanent intolerance to gluten proteins, it is distinct from wheat allergy, which is much rarer.
The only known effective treatment is a strict lifelong gluten-free diet, which leads to recovery of the intestinal lining (mucous membrane), improves symptoms, and reduces the risk of developing complications in most people. If untreated, it may result in cancers such as intestinal lymphoma, and a slightly increased risk of early death. Rates vary between different regions of the world, from as few as 1 in 300 to as many as 1 in 40, with an average of between 1 in 100 and 1 in 170 people. It is estimated that 80% of cases remain undiagnosed, usually because of minimal or absent gastrointestinal complaints and lack of knowledge of symptoms and diagnostic criteria. Coeliac disease is slightly more common in women than in men.
Coeliac disease causes a wide range of symptoms and complications that can involve several different organs. The presentation of coeliac disease can be classified as classic, non-classic, and subclinical. Classic coeliac disease is commonly seen in young children, but can affect any age group, and is characterized by malabsorption manifesting as diarrhoea, weight loss, and failure to thrive. Non-classic coeliac disease is seen more often in adults and symptoms primarily manifest outside of the intestine (extraintestinal). Many undiagnosed individuals who consider themselves asymptomatic are, in fact, not, but rather have become accustomed to living in a state of chronically compromised health. After starting a gluten-free diet and subsequent improvement becomes evident, such individuals are often able to retrospectively recall and recognise prior symptoms of their untreated disease that they had mistakenly ignored.
Diarrhoea that is characteristic of coeliac disease is chronic, sometimes pale, of large volume, and abnormally foul in odor. Abdominal pain, cramping, bloating with abdominal distension, and mouth ulcers may be present. As the bowel becomes more damaged, lactose intolerance may develop. Frequently, the symptoms are ascribed to irritable bowel syndrome (IBS), only later to be recognised as coeliac disease. In populations of people with symptoms of IBS, a diagnosis of coeliac disease can be made in about 3.3% of cases. Studies evaluating the prevalence of coeliac disease in those with IBS have had inconsistent results, making it unclear whether screening for coeliac disease is beneficial. However, several clinical guidelines recommend screening for coeliac disease in individuals with IBS symptoms.
Coeliac disease leads to an increased risk of both adenocarcinoma and lymphoma of the small bowel (enteropathy-associated T-cell lymphoma or other non-Hodgkin lymphomas) within the first year of diagnosis. Whether a gluten-free diet brings this risk back to baseline is unclear. Long-standing and untreated disease can rarely lead to other complications, such as ulcerative jejunitis (ulcer formation of the small bowel).
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Coeliac disease
Coeliac disease (Commonwealth English) or celiac disease (American English) is a chronic autoimmune disease, mainly affecting the small intestine, and is caused by the consumption of gluten. Coeliac disease causes a wide range of symptoms and complications that can affect multiple organs outside of the gastrointestinal tract.
The symptoms of coeliac disease can be divided into two subtypes, classic and non-classic. The classic form of the disease can affect any age group, but is usually diagnosed in early childhood and causes symptoms of malabsorption such as weight loss, diarrhoea, and stunted growth. Non-classic coeliac disease is more commonly seen in adults and is characterized by vague abdominal symptoms and complications in organs outside of the gastrointestinal tract, such as bone disease, anemia, and other consequences of nutritional deficiencies.
Coeliac disease is caused by an abnormal immune system response to gluten, found in wheat and other grains such as barley and rye. When an individual with a genetic predisposition to coeliac disease consumes gluten, it triggers an inflammatory response in the small intestine, damaging the intestinal lining, leading to malabsorption. The development of coeliac disease is believed to be influenced by other environmental factors, such as infections.
Diagnosis is typically made by a combination of blood antibody tests and intestinal biopsies, helped by specific genetic testing. Diagnosis is not always straightforward. About 10% of the time, the autoantibodies in the blood are negative, and many people have only minor intestinal changes with normal villi. People may have severe symptoms and they may be investigated for years before a diagnosis is achieved. As a result of screening, the diagnosis is increasingly being made in people who have no symptoms. Evidence regarding the effects of screening, however, is as of 2017, insufficient to determine its usefulness. While the disease is caused by a permanent intolerance to gluten proteins, it is distinct from wheat allergy, which is much rarer.
The only known effective treatment is a strict lifelong gluten-free diet, which leads to recovery of the intestinal lining (mucous membrane), improves symptoms, and reduces the risk of developing complications in most people. If untreated, it may result in cancers such as intestinal lymphoma, and a slightly increased risk of early death. Rates vary between different regions of the world, from as few as 1 in 300 to as many as 1 in 40, with an average of between 1 in 100 and 1 in 170 people. It is estimated that 80% of cases remain undiagnosed, usually because of minimal or absent gastrointestinal complaints and lack of knowledge of symptoms and diagnostic criteria. Coeliac disease is slightly more common in women than in men.
Coeliac disease causes a wide range of symptoms and complications that can involve several different organs. The presentation of coeliac disease can be classified as classic, non-classic, and subclinical. Classic coeliac disease is commonly seen in young children, but can affect any age group, and is characterized by malabsorption manifesting as diarrhoea, weight loss, and failure to thrive. Non-classic coeliac disease is seen more often in adults and symptoms primarily manifest outside of the intestine (extraintestinal). Many undiagnosed individuals who consider themselves asymptomatic are, in fact, not, but rather have become accustomed to living in a state of chronically compromised health. After starting a gluten-free diet and subsequent improvement becomes evident, such individuals are often able to retrospectively recall and recognise prior symptoms of their untreated disease that they had mistakenly ignored.
Diarrhoea that is characteristic of coeliac disease is chronic, sometimes pale, of large volume, and abnormally foul in odor. Abdominal pain, cramping, bloating with abdominal distension, and mouth ulcers may be present. As the bowel becomes more damaged, lactose intolerance may develop. Frequently, the symptoms are ascribed to irritable bowel syndrome (IBS), only later to be recognised as coeliac disease. In populations of people with symptoms of IBS, a diagnosis of coeliac disease can be made in about 3.3% of cases. Studies evaluating the prevalence of coeliac disease in those with IBS have had inconsistent results, making it unclear whether screening for coeliac disease is beneficial. However, several clinical guidelines recommend screening for coeliac disease in individuals with IBS symptoms.
Coeliac disease leads to an increased risk of both adenocarcinoma and lymphoma of the small bowel (enteropathy-associated T-cell lymphoma or other non-Hodgkin lymphomas) within the first year of diagnosis. Whether a gluten-free diet brings this risk back to baseline is unclear. Long-standing and untreated disease can rarely lead to other complications, such as ulcerative jejunitis (ulcer formation of the small bowel).