Coeliac disease

Coeliac disease is a long-term autoimmune disorder that primarily affects the small intestine. It occurs when genetically predisposed individuals consume gluten—a protein found in wheat, barley, and rye, causing an immune reaction that damages the lining of the small intestine. This damage impairs nutrient absorption, leading to a wide range of symptoms and complications.

While often associated with gastrointestinal symptoms, coeliac disease can present with varied and sometimes non-specific manifestations, including fatigue, anaemia, and skin disorders. Early detection and adherence to a strict gluten-free diet are essential to managing the disease and preventing long-term complications.

Coeliac disease is not a food allergy or intolerance but an autoimmune disorder. When a person with coeliac disease eats gluten, their immune system attacks the small intestine, specifically the villi—tiny finger-like projections responsible for nutrient absorption. As a result, individuals can suffer from malnutrition regardless of their food intake.

The condition is lifelong, and there is currently no cure other than a strict gluten-free diet. Coeliac disease can affect anyone but is more common in people with certain genetic markers (HLA-DQ2 or HLA-DQ8).

Global Prevalence

Coeliac disease is estimated to affect around 1% of the global population, though many cases remain undiagnosed. It is more commonly diagnosed in Western countries, partly due to increased awareness and better diagnostic facilities.

• Europe: Prevalence rates range from 0.3% to 2%
• United States: Estimated 1 in 133 people (about 1%)
• Australia: Approximately 1 in 70 people

Prevalence in India

In India, coeliac disease is increasingly recognised, particularly in northern regions like Punjab and Delhi. Studies suggest that around 1 in 100 Indians may have the condition, though underdiagnosis is still common due to limited awareness.

While there is only one form of coeliac disease, its presentation can vary significantly, leading to categorisation into the following types:

• Classical Coeliac Disease: Characterised by gastrointestinal symptoms such as diarrhoea, weight loss, and malnutrition.
• Non-classical Coeliac Disease: Presents with extraintestinal symptoms like anaemia, fatigue, osteoporosis, and infertility.
• Silent or Asymptomatic Coeliac Disease: No noticeable symptoms but still causes intestinal damage.
• Potential Coeliac Disease: Individuals test positive for coeliac antibodies but show no intestinal damage yet.
• Refractory Coeliac Disease: Persistent symptoms and intestinal damage despite a strict gluten-free diet.

Coeliac disease develops from a combination of genetic, environmental, and immunological factors:

• Genetics: Presence of HLA-DQ2 or HLA-DQ8 genes
• Gluten Consumption: Triggers immune response
• Infections: Early childhood gastrointestinal infections may increase risk
• Gut Microbiota: Imbalances may influence immune response
• Other Autoimmune Diseases: People with type 1 diabetes or thyroiditis are at higher risk

Symptoms can vary widely, making diagnosis challenging. Common signs include:

• Chronic diarrhoea or constipation
• Abdominal pain and bloating
• Nausea and vomiting
• Fatigue
• Weight loss despite a normal diet
• Anaemia (especially iron-deficiency)
• Skin rash (dermatitis herpetiformis)
• Delayed growth in children
• Osteoporosis or osteopenia
• Neurological symptoms: headaches, peripheral neuropathy

In children, symptoms may also include irritability, failure to thrive, and delayed puberty.

Accurate diagnosis is vital to avoid unnecessary dietary restrictions. Diagnostic steps include:

• Blood Tests:
  
  • Tissue transglutaminase antibodies (tTG-IgA)
  • Endomysial antibodies (EMA)
  • Total IgA levels to rule out IgA deficiency
• Genetic Testing:
  
  • HLA-DQ2 and HLA-DQ8 genes can confirm susceptibility but not the disease
• Endoscopy with Biopsy:
  
  • Gold standard for diagnosis; shows villous atrophy in the small intestine
• Patients must be consuming gluten before testing to avoid false negatives.

There is no cure for coeliac disease, and treatment revolves around a lifelong gluten-free diet. Key components include:

• Strict Gluten-Free Diet:
  
  • Avoid wheat, barley, rye, and any derivatives
  • Be cautious with cross-contamination in shared kitchens
• Nutritional Support:
  
  • Supplements for iron, calcium, vitamin D, B12, and folate. You can explore multivitamins on Dawaadost.
  • High-fibre, balanced diet for gut health
• Monitoring:
  
  • Regular follow-ups to assess symptom improvement and antibody levels
  • Bone density scans and other evaluations as needed
• Medications (if necessary):
  
  • Steroids for severe inflammation (rare). (Brand: Medrol 8 mg Tablet)
  • Enzyme supplements under research

While no alternative therapy can replace a gluten-free diet, some supportive approaches include:

• Probiotics and Prebiotics: May help restore gut flora
• Herbal Remedies: Caution advised due to potential gluten contamination
• Acupuncture and Yoga: Can relieve stress-related symptoms
• Gluten-Degrading Enzymes: Experimental supplements under research

Always consult a healthcare provider before trying alternative therapies.

Several factors may increase the risk of developing coeliac disease:

• Family history of coeliac disease
• Type 1 diabetes
• Autoimmune thyroid disease
• Down syndrome or Turner syndrome
• Other autoimmune conditions
• Early or excessive gluten introduction in infancy
• History of gastrointestinal infections

If untreated, coeliac disease can lead to severe complications:

• Malnutrition: Due to impaired nutrient absorption
• Osteoporosis: Low calcium and vitamin D levels
• Infertility or Miscarriages
• Lactose Intolerance: Secondary to gut damage
• Neurological Disorders: Ataxia, seizures
• Liver Disorders: Elevated liver enzymes
• Increased Cancer Risk: Intestinal lymphoma and small bowel cancer

Living with coeliac disease requires lifestyle adjustments:

• Read Food Labels: Always check for hidden gluten
• Cook at Home: Avoid cross-contamination and ensure safety
• Join Support Groups: Sharing experiences can help cope emotionally
• Educate Friends and Family: Helps prevent accidental exposure
• Travel Smart: Carry gluten-free snacks and research restaurants in advance

• Myth: Coeliac disease is just a food allergy
   Fact: It is an autoimmune condition with serious health risks
• Myth: A small amount of gluten is safe
   Fact: Even trace amounts can trigger a reaction
• Myth: Children outgrow coeliac disease
   Fact: It is a lifelong condition
• Myth: Gluten-free diet is healthier for everyone
   Fact: Only necessary for those with medical reasons

Seek medical advice if you or your child experiences:

• Persistent gastrointestinal symptoms
• Unexplained anaemia
• Fatigue, bone pain, or weight loss
• Delayed growth or puberty in children
• Family history of coeliac disease

• What tests are needed to confirm coeliac disease?
• How strict should the gluten-free diet be?
• Are there risks of nutritional deficiencies?
• Can other family members be affected?
• Will I need to see a dietitian?
• What follow-up tests are required?
• Can symptoms return despite a gluten-free diet?

• Understand Their Condition: Educate yourself about the disease
• Respect Dietary Needs: Avoid offering foods with gluten
• Create a Safe Kitchen Space: Prevent cross-contamination
• Listen and Be Patient: Managing the disease can be emotionally challenging
• Accompany Them to Appointments: Offer emotional support
• Encourage Compliance: Especially for children and teens
   

Coeliac disease is a serious autoimmune condition that requires lifelong management. With timely diagnosis and strict adherence to a gluten-free diet, individuals can lead healthy, symptom-free lives. Public awareness, proper screening, and supportive communities play a vital role in improving outcomes for those living with this condition.