Coeliac disease

Coeliac disease (CD) is an autoimmune disease caused by proteins in wheat, rye and barley. These proteins are called gluten. Because of some genetic factors, the small bowel of a coeliac does not tolerate gluten, and an immunological inflammation occurs damaging the villi in the small bowel. Due to the damaged villi, the bowel of a coeliac patient cannot utilise nutrients normally. This may lead to a wide variety of symptoms or signs of malabsorption. 

For more information on CD and gluten-free diet in English visit Coeliac Uk’s webpage.

Symptoms in coeliac disease

The Classical symptoms in coeliac disease are diarrhoea and weight loss and failure to thrive in children. However, today coeliac disease often presents with only mild symptoms of the stomach, such as pains, loos stools or flatulence.

Intolerance to lactose is often present also as the damaged bowel lacks lactase enzyme to break down lactose.

The nutritional and vitamin deficiencies may cause anaemia, osteoporosis and general tiredness and feeling unwell.

 

Diagnosis

Coeliac disease can be screened with different antibody blood tests (transglutaminase and endomysium antibody tests). For the final diagnosis a small bowel biopsy must be performed to find villous atrophy typical for coeliac disease.

Gluten-free diet should never be started before the small bowel biopsy investigation has been done. This is because the diet, kept long enough, will spoil the opportunity to set the correct diagnosis - the villi may have recovered and the typical coeliac disease findings can no longer be seen.

Rapid Test Available for Detecting Coeliac Disease

A quick and simple do-it-yourself testing kit for coeliac disease, developed in Finland, is available from pharmacies. Only a drop of blood from the fingertip is required and the test identifies the presence of coeliac antibodies in a matter of minutes.

Treatment

The only treatment for coeliac disease is a gluten-free diet, where wheat, rye and barley are strictly excluded. Gluten-free oats (oats, which have been produced without gluten contamination) can be included in gluten-free diet.

When gluten-free diet is started, the small bowel villi begins to recover and functions of the bowel and utilisation of nutrients normalise.

This does not mean that coeliac disease as such is cured. To keep the villi healthy and avoid symptoms, coeliacs need a life-long, strict gluten-free diet.

Dermatitis herpetiformis

Dermatitis herpetiformis (DH) or ”the coeliac disease of the skin” is a very itchy rash, which usually appears on the convex areas of the body, such as knees, elbows, scalp and buttocks. Most of the individuals with DH have similar small bowel villous damage to those seen in coeliac disease. Coeliac disease and DH may also appear in the same families. 

The diagnosis of DH is made by a skin biopsy, and often a small bowel biopsy is taken too. One should not start the gluten-free diet before the biopsy is taken. The treatment of DH is gluten-free diet. The symptoms of the skin disappear slowly after starting the diet. Sometimes additional medical treatment is used.