Digestive health centre

Coeliac disease

Coeliac disease is a digestive and autoimmune disorder that results in damage to the lining of the small intestine when foods with gluten are eaten. Gluten is a form of protein found in some grains. The damage to the intestine makes it hard for the body to absorb nutrients, especially fat, calcium, iron and folate.

What causes coeliac disease?

Normally, the body's immune system is designed to protect it from foreign invaders. When people with coeliac disease eat foods containing gluten, their immune system forms antibodies to gluten that then attack the intestinal lining. This causes inflammation in the intestines and damages the villi, the hair-like structures on the lining of the small intestine. Nutrients from food are absorbed by the villi. If the villi are damaged, the person cannot absorb nutrients and ends up malnourished, no matter how much he or she eats.

What are the symptoms of coeliac disease?

Symptoms of coeliac disease vary among sufferers and include:

• Digestive problems (abdominal bloating, pain, wind, diarrhoea, pale stools, and weight loss).
• A severe skin rash called dermatitis herpetiformis.
• Anaemia (low blood count).
• Musculoskeletal problems (muscle cramps, joint and bone pain).
• Growth problems and failure to thrive (in children).
• Seizures.
• Tingling sensation in the legs (caused by nerve damage and low calcium).
• Aphthous ulcers (sores in the mouth).
• Missed menstrual periods. 

What health problems accompany coeliac disease?

Coeliac disease can leave a person susceptible to other health problems, including:

• Osteoporosis, a disease that weakens bones and leads to fractures. This occurs because the person has trouble absorbing enough calcium and vitamin D.
• Miscarriage or infertility.
• Birth defects, such as neural tube defects (improper formation of the spine) caused by poor absorption of such nutrients as folic acid
• Seizures.
• Growth problems in children because they don't absorb enough nutrients.
• Cancer of the intestine (very rare).

People who have celiac disease may have other autoimmune diseases, including:

• Thyroid disease
• Type 1 diabetes
• Lupus
• Rheumatoid arthritis
• Sjögren's syndrome (a disorder that causes insufficient moisture production by the glands)

How is coeliac disease diagnosed?

If your doctor suspects you have coeliac disease, he or she will perform a careful physical examination and will discuss your medical history with you. He or she may also perform a blood test to measure for higher levels of certain types of antibodies (substances produced by the immune system to fight harmful invaders) found in people with coeliac disease.

Your doctor may perform other tests to detect nutritional deficiencies, such as a blood test to detect iron levels; a low level of iron (which can cause anaemia) can occur with coeliac disease. A stool sample may be tested to detect fat in the stool, since coeliac disease prevents fat from being absorbed from food.

Your doctor may arrange for you to have a biopsy from your small intestine to check for damage to the villi. In a biopsy, the doctor inserts an endoscope (a thin, hollow tube) through your mouth and into the small intestine, and takes a sample of the small intestine with an instrument to examine under a microscope.