Overview

This information factsheet is about Coeliac Disease

Coeliac disease is an autoimmune condition, which occurs in people who become sensitive to a protein called gluten in their diet. Gluten is found in wheat, barley and rye and is normally a nourishing and harmless part of the food we eat. However, if you have coeliac disease, gluten causes damage to the lining of your small intestine. This can cause problems with the absorption of nutrients and vitamins that we eat. Coeliac disease can be diagnosed at any age; from infancy to old age, although most people diagnosed are over 40. The treatment, which is usually very successful, is to remove all sources of gluten from the diet.

Over the past few years, it has become clear that coeliac disease is much more common than we used to think. Recent research has shown that approximately one in 100 people in the UK have this condition. It is known to occur more frequently in Caucasian populations in Europe and also in developing countries where wheat is a staple diet (the west of Ireland has the highest rate of the disease in the world). The incidence of coeliac disease in people with first-degree relatives (parent, child, sibling) who have coeliac disease is 1 in 10 (British Society of Gastroenterology guidelines ‘The management of adults with coeliac disease), and with second degree relatives (aunt, uncle, cousin) who has coeliac is 1 in 394. Some people who have coeliac disease don’t actually know they have it but may still have some mild symptoms and it is thought that only 1 in 800 people have been correctly diagnosed with coeliac disease in the UK.

How can coeliac disease affect you?

Viewing a normal small intestine under the microscope, there will be vast numbers of tiny finger like projections sticking up from the surface. These are villi and their purpose is to increase the absorption of nutrients from our diet. In a person with coeliac disease, the villi have been damaged by inflammation and they will look shorter and stubbier meaning that fewer nutrients pass into the bloodstream.

In more severe cases, they can barely be seen at all so the lining of the intestine looks quite flat. Doctors call this villous atrophy. Recognising villous atrophy is the key to making the diagnosis of coeliac disease. If
patients with coeliac disease stop eating gluten, the villi can recover.

The main ways that coeliac disease can affect the body is:

  • Physical discomfort: bloating, abdominal discomfort, diarrhoea, unexplained weight loss.
  • Shortage of essential nutrients: this can lead to other conditions such as osteoporosis or anaemia.

Causes

Causes of coeliac disease

We do not know why people develop this condition but there are many theories. Most doctors believe that a factor in our genes determines whether our intestines become sensitive to gluten. Like many illnesses, coeliac disease can run in families and the specific genes are now being identified.

Symptoms

What are the usual symptoms of coeliac disease?

There is a wide variation in the symptoms experienced. In children, there may be diarrhoea, vomiting or a failure to gain weight. In adults, the disease comes to medical attention in a wide variety of ways. A common symptom is diarrhoea with bloating or discomfort in the abdomen. Quite often, patients don’t have any symptoms that might relate to their guts but coeliac disease is suspected if tests show anaemia or they are found to have thin bones (osteoporosis). Such diseases of the blood and bones may occur because patients cannot absorb iron, calcium and several vitamins from their diet due to the damaged villi. In other cases, people lose weight for no obvious reason or just feel unwell in a rather vague way. Many patients have only mild symptoms.

How is coeliac disease diagnosed?

The doctor will carry out an examination and take a medical history. If they suspect coeliac disease, further tests will be carried out:

  • Blood tests: these will be looking for antibodies indicative of coeliac disease and must be done whilst gluten containing food is still being eaten. However, a positive blood test does not confirm the diagnosis beyond doubt.
  • Endoscopy: this will be carried out if the result is positive, or in situations where the blood test is negative but there is still a possibility of coeliac disease. Endoscopy involves passing a thin, flexible tube through the mouth and down through your gut to the small intestine where biopsies are taken. Neither passing the tube nor taking biopsies are painful although the procedure may be uncomfortable. The biopsy samples will show whether or not the villi are abnormal and confirm the diagnosis. Sometimes, a second endoscopy and biopsy may be suggested if there was uncertainty about the diagnosis.

The treatment of coeliac disease requires a special diet for life and it’s absolutely crucial to be certain about the diagnosis. Endoscopy is the only way to confirm diagnosis.

Treatment

What treatment is available for coeliac disease?

The treatment for coeliac disease is to avoid eating any foods, which contains gluten. This means following a gluten-free diet for the rest of your life. If you are diagnosed with coeliac disease, the doctor will suggest you consult a dietitian as sticking to a gluten-free diet requires knowledge about which foods contain gluten and how to maintain a balanced diet. The dietitian will provide written information and advice.

What is a gluten free diet?

Gluten is present in any foods that are made using wheat, rye or barley. Bread, pastry and cakes are all made with flour and contain large amounts of gluten. Breakfast cereals are often made from wheat, rye and barley with lots of other foods unexpectedly turning out to contain gluten. For example, flour is used as a thickener in many cooking sauces and barley is used in making all beers and lagers. Some foods occasionally get contaminated with small amounts of gluten during production or processing. Oats are not believed to be harmful to people with coeliac disease, but some products made from oats may contain traces of gluten, which make them unsafe to eat. It is worth learning to check the labels on such products to see if they are gluten-free.

There are a wide variety of alternative gluten-free products available for people with coeliac disease. A range of specialist substitute staple glutenfree foods is available on prescription from the doctor to help people with diagnosed coeliac disease adhere to a life-long strict gluten-free diet. The Advisory Committee on Borderline Substances (ACBS), an independent body advising the Department of Health, has approved a list of staple foods that form the basis of a nutritionally balanced diet. These foods include bread, flour replacement mixes, pasta, crackers and plain breakfast cereals containing no added sugar. Some of these foods are fortified with key nutrients such as calcium and fibre, which can be lacking in gluten-free diets.

Mainstream manufacturers now make gluten-free foods and many of these, including luxury items, are available from supermarkets and health food shops. Current legislation requires food manufacturers to label foods so that all individual ingredients must be clearly stated. Most manufacturers label their products as gluten-free, but generally gluten should be listed as an ingredient where present. Restaurants are increasingly trying to help by indicating the use of gluten in dishes. However many restaurants currently do not label their meals and you may have to ask. In addition, food labelling rules may not be as strict in countries outside the UK, so it is important to be careful when travelling.

You should learn to check all foods and be aware of gluten-free sections of the supermarkets.

  • Use of food directory/App for guidance on products in supermarkets.
  • Maintaining a healthy diet.
  • Not relying on processed GF foods too much as they can be high in sugar content.

Coeliac UK (formerly the Coeliac Society) provides a large amount of information for people with coeliac disease. Your doctor will encourage you to become a member if you are diagnosed with coeliac disease. Coeliac UK (www.coeliac.org.uk) publishes a list of gluten-free products in a handbook, which is updated every year and a magazine that provides information about new products, recipes, social and educational events and research developments and links to other sources of information. A phone app is also available to help when people are out shopping as a quick reference guide. The Coeliac UK helpline is 0333 332 2033 or visit www.coeliac.org.uk

Support

How can coeliac disease affect me over time?

This condition does not go away. You are far less likely to develop future problems and stay healthy if you stick to a gluten-free diet. Most people find it easier to follow the diet once they have got used to it.

There is a risk of developing problems such as a low iron count (anaemia) or thinning of the bones (osteoporosis) but these are far less likely if you eat the correct foods. If you do develop these problems, your doctor may put you on tablet supplements before starting the diet. Women with coeliac disease can have fertility problems but these usually resolve once the gluten-free diet has started.

Having coeliac disease may increase your risk of having certain types of cancer. There is a rare form of tumour called a Lymphoma which can affect the bowel and which does occur in a very small number of people with coeliac disease after many years, especially if they continue to eat gluten. If you have coeliac disease and adhere to the diet, you can expect the same life expectancy as anyone else.

Does my coeliac disease need monitoring?

As you might develop problems in the future, it is worth keeping an eye on your health. It is recommended that you have a check-up once a year to ensure all is well. It is a good idea to have annual blood tests to ensure you are not anaemic or have become short of vitamins and other nutrients.

Your doctor may also arrange for you to have a simple scan of your bones from time to time to look for any sign that the bones have become thin so this can be treated early. People with coeliac disease are less able to produce antibodies to infections, so that vaccinations against flu and pneumococcal infections may be recommended.

What to ask your doctor

  • Where are the best sources of information about living gluten free?
  • Are there any support groups for coeliac disease in my area?
  • Should my close family be tested for coeliac disease?
  • How often will you be monitoring me for anaemia and osteorosis? Can I have a bone scan?

What other resources and organisations can help?

Coeliac UK

Coeliac UK is the leading UK charity supporting people diagnosed with coeilac disease.

www.coeliac.org.uk

Research