Coeliac disease a relatively common condition. It is estimated 1 % of the UK population have Coeliac disease. It is caused by an immunological reaction to gluten, a protein found in wheat, and other similar proteins found in rye, barley and oats. As a consequence of this reaction, the mucosal surface of the small bowel is damaged, with loss of the small finger-like projections (villi) that line the small intestine. These villi are usually present on the surface of every cell lining the small bowel. They play a significant role in digestion by increasing the surface area of the small bowel, thereby enabling absorption of nutrients. When damaged and inflamed, the villi are lost and malabsorption can occur which often leads to symptoms such as diarrhoea and malnutrition (significant weight loss).

What are the symptoms?

People with Coeliac experience a wide range of symptoms. Diarrhoea is one of the most common symptoms to affect people of all ages with Coeliac disease.

Children may not gain weight or grow properly, while adults may find they lose weight. Malabsorption can also lead iron or folate deficiency, which can lead to anaemia and symptoms of fatigue and breathlessness.

People with Coeliac can also experience recurrent mouth ulcers, vomiting and abdominal pain. An itchy rash on the elbows and knees may occur.

Possible long-term problems include infertility, osteoporosis and bowel cancer.

 Whose is affected?

The average incidence in the UK is one in 100 people and men and women seem to be affected equally.

The condition runs in families and was once thought to affect only children. However, many adults are now being diagnosed with the disease. It’s particularly common between the ages of 30 and 45 years.

Coeliac disease is more common among people with so-called autoimmune disorders including type 1 (insulin-dependent) diabetes, autoimmune thyroid disease, osteoporosis, ulcerative colitis and epilepsy. It is recommended that individuals with type 1 DM be screened for Coeliac disease.

People from the west of Ireland are more often affected, as are those from the Punjab region of India, Pakistan, the Middle East and North Africa.

It’s important to consult your GP if you suspect coeliac disease. Its possible people who think they have wheat intolerance may have undiagnosed Coeliac disease.

How is Coeliac Disease diagnosed?

A specialised blood test has been developed to help doctors decide whether or not a patient has coeliac disease. This can result in a false negative result and where there is a strong clinical suspicion that someone might have Coeliac, they should undergo a gastroscopy with duodenal biopsy.

If people are found to have a positive blood test (anti-endomysial antibody) they are recommended to undergo a gastroscopy and have a biopsy taken from the

How is Coeliac Disease treated?

There’s no cure for coeliac disease, but it can be controlled by following a gluten-free diet. Avoiding gluten leads to a resolution of the immune reaction and recovery of the intestinal villi. Nutrients can then be absorbed normally again and symptoms improve.

The risk of someone with coeliac disease developing bowel cancer is believed to be no more than that of someone who doesn’t have coeliac disease, provided they stick to a gluten-free diet.

It’s important to see a dietician to understand which foods are gluten-free (fruit, vegetables, fresh meat, fish, cheese, eggs, and milk) and which contain wheat, barley and rye, and should be avoided or replaced with products such as rice or corn flour. These days food labeling makes things easier. Recipe books and gluten-free foods are readily available.

A test for osteoporosis (DEXA scan) is recommended at some time, so that appropriate treatment can be given if necessary. A diet rich in calcium and vitamin D and regular weight-bearing exercise are essential to help prevent osteoporosis from developing.

If I have Coeliac disease am I more susceptible to infection ?

No there is no evidence people with infection are more susceptible to infection. Very occasionally, people with Coeliac have hyposplenism, that is, their spleen does not function very well.  This potentially puts them at risk of pneumococcal infections.  Very occasionally people with Coeliac disease maybe treated with steroids and or azathioprine, if they symptoms do not improve with GFD. Such people will potentially be at increased risk of infection but will be counseled regarding individual risks prior to starting the treatment.

Vaccinations and Coeliac

There is no specific guidance for people with coeliac disease on the need for vaccinations. The Department of Health recommends a vaccination for seasonal flu and pneumococcal disease for:

People over the age of 65.

People with a heart condition, chronic lung disease, chronic renal disease, diabetes mellitus, a weakened immune system or a damaged or absent spleen.

We know that some people with coeliac disease are ‘hyposplenic and those people who are known to be hyposplenic should receive the pneumococcal vaccine and also vaccines to meningitis C and influenza.

Pneumococcal disease is an infection caused by a bacterium that usually lives harmlessly at the back of many people’s throats.  However, it can invade other parts of the body and cause serious, possibly life-threatening illnesses including pneumonia, septicaemia or meningitis.

If you have coeliac disease, immunisation against pneumococcal disease and seasonal flu needs to be considered on an individual basis.  If you are concerned about this issue, your GP is best placed to discuss this with you.

Advice and support

Useful advice is always available from the Coeliac society

Coeliac UK

Helpline: 0870 444 8804

Website: www.coeliac.org.uk

Nice guidance is available www.nice.org.uk/CG86