Celiac disease, also spelt as Coeliac, and occasionally called celiac sprue or gluten-sensitive enteropathy, is a condition where the immune system attacks your own tissues when you eat gluten.

This damages your gut (small intestine) which is an immune reaction to eating gluten, a protein found in wheat, barley and rye. Over time, this reaction damages your small intestine’s lining and prevents it from absorbing some nutrients (malabsorption). The intestinal damage often causes diarrhoea, fatigue, weight loss, bloating and anaemia, and can lead to serious complications.

Coeliac disease is a disorder that affects at least 1 in every 100 people in the UK. Some professionals think this may be undervalued due to milder cases that may go undiagnosed or be misdiagnosed as other digestive conditions, such as irritable bowel syndrome. Reported cases of coeliac disease are approximately 3 times higher in females than males.

Celiac disease can be developed at any age, though symptoms are most likely to develop:

• throughout early childhood – between 8 and 12 months old, whilst it could take numerous years before a precise diagnosis is made
• in later adulthood – between 40 and 60 years of age Individuals with certain conditions, such as type 1 diabetes, autoimmune thyroid disease, down syndrome and Turner syndrome, have an increased risk of getting coeliac disease.
• First-degree relatives (parents, brothers, sisters and children) of individuals with coeliac disease are also at larger risk of developing the condition.

Sadly, there’s no cure for celiac disease, but for most individuals, following a strict gluten-free diet will help manage symptoms and promote intestinal healing. However, more than half the adults with celiac disease have signs and symptoms unrelated to the digestive system, including:

• Anaemia, usually from iron deficiency
• Loss of bone density (osteoporosis) or softening of bone (osteomalacia)
• Itchy, blistery skin rash (dermatitis herpetiformis)
• Mouth ulcers
• Headaches and fatigue
• Nervous system injury, including numbness and tingling in the feet and hands, possible problems with balance, and cognitive impairment
• Joint pain
• Reduced functioning of the spleen (hyposplenism)

Children with celiac disease are more likely than adults to have digestive problems, malabsorption which can affect growth and development, besides causing the symptoms seen in adults. Including: 

• Nausea and vomiting
• Chronic diarrhoea
• Swollen belly
• Constipation
• Gas
• Pale, foul-smelling stools

The inability to absorb nutrients might result in:

• Failure to thrive for infants
• Damage to tooth enamel
• Weight loss
• Anaemia
• Irritability
• Short stature
• Delayed puberty

Also, neurological symptoms, involving attention-deficit/hyperactivity disorder (ADHD), learning disabilities, headaches, lack of muscle coordination and seizures

Celiac disease inclines to run in families. If somebody in your family has the condition, speak with your doctor to see if you need to be tested. 

Speak with your doctor if you have diarrhoea or digestive discomfort that continues for beyond than two weeks. Also speak with your child’s doctor if your child is pale, irritable or failing to grow or has a potbelly and foul-smelling, bulky stools. And you must discuss with your GP before trying a gluten-free diet. If you stop or even reduce the amount of gluten you eat before you’re tested for celiac disease, you can change the test results.

Gluten intolerance can cause this itchy, blistering skin disease. The rash usually occurs on the elbows, knees, torso, scalp and buttocks. This disorder is often related with changes to the lining of the small intestine alike to those of celiac disease, but the skin condition might not cause digestive symptoms. Doctors treat dermatitis herpetiformis with a gluten-free diet or medication, or both, to control the rash.

Your genetic factors combined with eating foods with gluten and other factors can contribute to celiac disease, but the specific cause isn’t known. Infant-feeding practices, gastrointestinal infections and gut bacteria might contribute, as well. Occasionally celiac disease can become active after surgery, pregnancy, childbirth, viral infection or severe emotional stress. Once the body’s immune system overreacts to gluten in food, the reaction damages the tiny, hair like projections (villi) that line the small intestine. Villi absorb vitamins, minerals and other nutrients from the food you eat. If your villi are impaired, you can’t get enough nutrients, no matter how much you eat. 

Routine testing for celiac disease is not recommended unless you have symptoms or an increased risk of developing them:

Testing for coeliac disease involves having: 

• Blood tests
• A biopsy 

Whilst being tested for celiac disease, you’ll need to eat foods containing gluten to guarantee the tests are accurate. You should also ear normally and not start a gluten-free diet pending the diagnosis is confirmed by a specialist, even if the results of blood tests are positive. If coeliac disease antibodies are found in your blood, your doctor will refer you for a biopsy of your gut. Nevertheless, it’s occasionally possible to have coeliac disease and not have these antibodies in your blood. If you continue to have coeliac disease-like symptoms despite having a negative blood test, your GP may still recommend you have a biopsy.

Tests after diagnosis:

If diagnosed with coeliac disease, you might have further tests to identify how the condition has affected you so far. Such as iron levels, vitamins and minerals this can identify whether coeliac disease has led to you developing anaemia. You may also undergo a skin biopsy if you appear to have dermatitis herpetiformis (An itchy rash caused by gluten intolerance). Furthermore, you may need a DEXA scan to confirm any thinning of the bones potentially caused by coeliac disease.

Risk factors:

Celiac disease inclines to be more common in individuals who have:

• A family member with celiac disease or dermatitis herpetiformis
• Type 1 diabetes
• Down syndrome or Turner syndrome
• Autoimmune thyroid disease
• Microscopic colitis (lymphocytic or collagenous colitis)
• Addison’s disease

Complications:

Complications of coeliac disease only incline to affect individuals who continue to eat gluten, or those who have not yet been diagnosed with the condition, which could be a common problem in milder cases.

Untreated, celiac disease can cause:

• Malnutrition. This happens if your small intestine can’t absorb enough nutrients. Malnutrition could lead to anaemia and weight loss. In youngsters, malnutrition could cause slow growth and short stature.
• Bone weakening. Malabsorption of calcium and vitamin D could lead to a softening of the bone (osteomalacia or rickets) in children and a loss of bone density (osteopenia or osteoporosis) in adults.
• Infertility and miscarriage. Malabsorption of calcium and vitamin D can contribute to reproductive problems.
• Lactose intolerance. Damage to your small intestine may cause abdominal pain and diarrhoea following eating or drinking dairy products that contain lactose. When your intestine has healed, you may be able to tolerate dairy products again.
• Cancer. People with celiac disease who don’t maintain a gluten-free diet have a larger risk of developing numerous forms of cancer, including intestinal lymphoma and small bowel cancer.
• Nervous system problems. Several individuals with celiac disease could develop difficulties such as seizures or a disease of the nerves to the hands and feet (peripheral neuropathy).

Nonresponsive celiac disease:

Several individuals with celiac disease don’t respond to what they believe to be a gluten-free diet. Nonresponsive celiac disease is frequently due to contamination of the diet with gluten. Working with a dietitian can help you learn how to avoid all gluten.

Individuals with nonresponsive celiac disease might have:

• Bacteria in the small intestine (bacterial overgrowth)
• Microscopic colitis
• Poor pancreas function (pancreatic insufficiency)
• Irritable bowel syndrome
• Difficulty digesting sugar found in dairy products (lactose), table sugar (sucrose), or a type of sugar found in honey and fruits (fructose)

Refractory celiac disease:

In extraordinary cases, the intestinal injury of celiac disease doesn’t respond to a strict gluten-free diet. This is known as refractory celiac disease. If you still have signs and symptoms after following a gluten-free diet for six months to one year, you may need additional testing to look for other reasons for your symptoms. 

Treating Celiac disease

There’s no cure for coeliac disease, but following a gluten-free diet ought to help regulate symptoms and avoid the long-term problems of the condition.

Even if you have mild symptoms, altering your diet is still suggested since continuing to eat gluten could lead to severe complications. This could also be the case if tests show that you have some degree of coeliac disease even if you do not have obvious symptoms.

It’s vital to ensure that your gluten-free diet is healthy and balanced. A rise in the range of available gluten-free foods in current years has made it promising to eat both a healthy and varied gluten-free diet.

Coeliac disease is caused by an adverse reaction to gluten, which is a dietary protein found in 3 types of cereal:

• wheat
• barley
• rye

Gluten is found in any food that contains those cereals, including:

• pasta
• cakes
• breakfast cereals
• most types of bread
• certain types of sauces
• some ready meals
• Most beers 

Symptoms of celiac disease:

Eating foods that contain gluten can trigger a range of gut symptoms, such as:

• Diarrhoea 
• Stomach aches 
• Bloating and farting 
• Indigestion 
• Constipation
• Tiredness

Celiac disease can also cause more general symptoms, including:

• Tiredness 
• Unintentional weight loss 
• An itchy rash 
• Infertility 
• Nerve damage 
• Ataxia – Disorders that effect balance and speech
• Delayed puberty in children and stunted growth.

If your doctor has diagnosed you with celiac disease, you may be entitled for gluten free staple foods on prescription. Just like getting medicine on prescription, your GP can write a prescription which you can collect from your pharmacist.

Support Groups:

Most individuals feel overwhelmed when they first receive their diagnosis. So, support groups can provide help and support whether you are newly diagnosed or have been living with it for years. Contact your doctor for information for your local support groups.