coeliac diseaseAlternative Names
coeliac sprue, nontropical sprue, sprue, gluten-sensitive enteropathy, gluten intolerance
Coeliac disease is a malabsorption syndrome. The intestine is not able to absorb vital dietary nutrients from foods. Due to a sensitivity of foods containing gliadin, an alcohol-soluble portion of gluten.
What is going on in the body?
Nutritional considerations are important for persons with coeliac disease. People with coeliac disease are sensitive to cereal protein found in wheat and other grains. But they are more sensitive to the protein in wheat than the protein in other cereals such as rye, oats, and barley. The protein causes a reaction in the person's small intestine that prevents absorption of essential nutrients from the diet. The defect in absorption leads to the symptoms of the disease and malnutrition.
What are the signs and symptoms of the disease?
The symptoms of coeliac disease are:
What are the causes and risks of the disease?
Coeliac disease is suspected to be a genetic disorder. But exactly how the genetic changes cause the sensitivity to gluten is not known.
Coeliac disease, for example, is common among people from northwest Europe. The frequency among the British is 1 in 1,000 to 1 in 2,000. The frequency among the Irish is as high as 1 in 600. In Australia the incidence is about 1 in 1000. Relatives of people with coeliac disease are at higher risk than others in the same population.
What can be done to prevent the disease?
There is no way to prevent coeliac disease. Genetic testing may be useful in some cases.
How is the disease diagnosed?
Coeliac disease may be diagnosed by observing the symptoms after an infant begins eating cereals. More often, however, it is diagnosed during the second year of life. The age and onset of coeliac disease can vary, though, and adults may be diagnosed with it. Specific blood tests for antibodies in the blood can be used to make the diagnosis.
Stool may be examined for excessive amounts of fat as this is a common sign of coeliac disease. A doctor may also order a barium enema x-ray study of the small bowel to check for increased intestinal secretion and clumping of the barium in the bowel. When coeliac disease is suspected, an endoscopy may be performed, and a biopsy of the small intestine may be done. The biopsy shows an abnormal inner surface of the small intestine.
What are the long-term effects of the disease?
The long-term effects of coeliac disease include:
- anaemia, which is a reduction in the number of red blood cells circulating in the blood
- delayed growth
- bone loss. Bone loss can cause osteomalacia or osteoporosis in adults, with bone pain and tenderness. Bone loss in children is seen as rickets, with bowlegs, a protruding stomach and a pigeon breast.
- defects of the nervous system
- inflammation of the skin
- malignant lymphoma
What are the risks to others?
Coeliac disease is not contagious. It is an inherited disease, but the way it is inherited is not clear. Genetic counselling is useful for those at risk of passing it to their children. The risk for identical twins may be as high as 70%. The risk for other brothers and sisters is 10%. The risk for children of parents with coeliac disease is 5-10%.
What are the treatments for the disease?
Many of the effects of coeliac disease can be minimised with a special diet. People with coeliac disease learn to avoid the proteins in cereal. The proteins in wheat, rye, barley, and oats cause the symptoms of the disease. A doctor may recommend a gluten-free diet. Gluten, the substance that seems to cause the symptoms in coeliac disease is found in wheat, rye, barley, oats, corn and rice. Gluten is not found in corn or rice. People with the disease cannot tolerate wheat, rye, barley and oats or any products made with these grains. They can eat corn and rice because these grains do not contain gluten. Some people may be able to tolerate oats, but this should not be tested until initial recovery has occurred. Some people do not respond to dietary limitations, and may need steroid therapy.
What are the side effects of the treatments?
Use of steroids may cause memory loss, bone loss, weight gain, congestive heart disease, or high blood pressure.
What happens after treatment for the disease?
Dietary restriction or drug therapy will be needed throughout the person's life.
How is the disease monitored?
Coeliac disease is monitored by simple observation of symptoms.
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 16/09/2004
Potential conflict of interest information for reviewers available on request