Coeliac disease

Overview

Coeliac disease is a congenital overreaction of the immune system to gluten. The disease causes gastrointestinal problems such as diarrhoea and bloating. The inability to properly absorb nutrients can lead to abnormal development and deficiencies. The mainstay of treatment is a strict, lifelong gluten-free diet.

Symptoms

Basically tend to vary (asymptomatic progression is possible)

Main symptoms

• Gastrointestinal problems
  • Diarrhoea after eating foods containing gluten
  • Fatty stools: foul-smelling, oily appearance, bulky
  • Excretion of partially digested food
  • Bloating, “big belly”
• Weight loss, abnormal development and delayed puberty in children
• Lethargy and lack of appetite

Other symptoms

• Nausea, vomiting
• Weakness
• Anaemia due to iron deficiency
  • Burning tongue
  • Pale skin
  • Cracks in skin at the corners of the mouth

Complications

• Signs of deficiency (including swelling/oedema, muscle wastage and muscle cramps, hair loss)
• Osteoporosis (because of vitamin D and calcium deficiency)
• Gynaecological problems (incl. menstrual disorders, reduced fertility)

Causes and treatment

Causes

• Genetic factors (major role)
  • Direct relatives fall ill in 10 to 15% of cases
• Immunological processes
  • Formation of auto-antibodies against intestinal mucosa
  • Decrease in surface area of intestinal mucosa (caused by complex inflammatory processes)
  • Lack of mucosal enzymes
  • Food can't be digested properly (maldigestion) and absorbed into the bloodstream (malabsorption)
• Lifelong tendency to overreact to gluten/gliadin
• Likelihood for coeliac disease is higher for people suffering from:
  • Diabetes mellitus Type I (diabetes)
  • Thyroid disorders
  • Rheumatic conditions
  • Down syndrome (trisomy 21)

Further treatment by your doctor / in hospital

Possible tests

• Physical examination
• Blood test (search for specific auto-antibodies)
• Stool analysis (search for fat in stool)
• Removal of tissue samples (biopsy) from duodenum

Possible therapies

• Lifelong gluten-free diet (central)
• The cause can't be healed
• If necessary, supplementation with fat-soluble vitamins (A, D, E, K) and some trace elements (calcium, magnesium, iron)

What can I do myself?

• It’s important to stick to a lifelong gluten-free diet
  • Avoid products containing wheat, rye, barley and spelt (e.g. pasta, cake, bread, but also beer)
  • Additives such as stabilisers and thickening agents in many ready-to-eat products contain gluten or gliadin
  • Recommended foods: rice, corn, potatoes, soya, buckwheat, millet, quinoa, amaranth, maybe oats
• Initially feed babies a gluten-free diet
• Only add small amounts of gluten during weeks 17 to 26.

When to see a doctor?

• Constant diarrhoea, bloating and fatty stools
• Abnormal development in children
• Unexplained weight loss

Further information

IG Celiac Association of Switzerland (IG Zöliakie der Deutschen Schweiz)
www.zoeliakie.ch

Synonyms

coeliac disease, non-tropical sprue, gluten-sensitive enteropathy