The lower limb in Coeliac's Disease

Coeliac disease

Autoimmune disorder that results in a reaction to gluten

Medical condition

Coeliac disease (Commonwealth English) or celiac disease (American English) is a chronic autoimmune disease, mainly affecting the small intestine. It is caused by an abnormal immune system response to gluten, found in wheat and other grains such as barley and rye. Coeliac disease causes a wide range of symptoms and complications that can affect multiple organs outside the gastrointestinal tract.

The classic form of the disease can affect any age group, but is usually diagnosed in early childhood and causes symptoms of malabsorption such as weight loss, diarrhoea, and stunted growth. Non-classic coeliac disease is more commonly seen in adults, characterised by vague abdominal symptoms and complications in organs outside the gastrointestinal tract, such as bone disease, anaemia, and other consequences of nutritional deficiencies. In people with a genetic predisposition to the condition, eating gluten causes inflammation in the small intestine, damaging its lining and leading to malabsorption. The development of coeliac disease is believed to be influenced by other environmental factors, such as infections.

Diagnosis is based on symptoms, blood tests, and biopsies of the small intestine. For people who have already cut out gluten, gluten may need to be reintroduced before testing to ensure an accurate diagnosis. The diagnosis is often complicated by the diverse symptoms, overlap with other disorders, and lack of awareness, leading to a delay in diagnosis. Current research indicates that there is not enough evidence to advocate for mass screening for coeliac disease in those without symptoms.

The only treatment for coeliac disease is a lifelong gluten-free diet (GFD). A GFD involves removing all food and drink that contains wheat, rye, barley and gluten derivatives. Symptoms can improve within days of adopting a GFD, and the diet can improve quality of life, prevent further complications, and normalise some effects of the disease such as stunted growth.

Approximately 1 in 200 to 1 in 50 people have coeliac disease. Diagnoses of coeliac disease have increased recently due to increased awareness and availability of blood testing. The disease is still thought to be underdiagnosed, with a significant number of people with the condition remaining undiagnosed and untreated. Most people develop the disease before the age of 10; it is slightly more common in women than in men.

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