Coeliac Disease

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Dr Chong Choon Seng

MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)

Coeliac disease is a chronic autoimmune disorder where consuming gluten (a protein found in wheat, barley, and rye) triggers an immune response that damages the small intestine’s lining. Over time, this damage impairs nutrient absorption, leading to a wide range of symptoms that can affect both the digestive system and other parts of the body.

If unmanaged, it can result in long-term complications, including malnutrition and other health conditions.

Symptoms of Coeliac Disease Symptoms of Coeliac Disease

Symptoms of Coeliac Disease

The symptoms of coeliac disease can differ widely between individuals and may affect multiple systems in the body. Common symptoms include:

  • Gastrointestinal symptoms: Diarrhoea, bloating, abdominal pain, and flatulence are commonly experienced. Constipation may occur in some cases instead of diarrhoea.
  • Nutritional deficiencies: Fatigue, weight loss, and anaemia caused by iron or vitamin B12 deficiency are common due to poor absorption of nutrients.
  • Skin issues: Dermatitis herpetiformis, an intensely itchy rash with blisters, is a potential manifestation of coeliac disease.
  • Neurological symptoms: Patients may experience headaches, anxiety, depression, or tingling and numbness in the extremities (peripheral neuropathy).
  • Bone and joint problems: Impaired calcium and vitamin D absorption can lead to osteoporosis, joint pain, or frequent fractures.
  • Growth and development issues in children: Children may experience stunted growth, delayed puberty, and developmental concerns.

Causes and Risk Factors

Coeliac disease develops due to a combination of genetic and environmental factors, as well as the consumption of gluten.

  • Genetics: The presence of specific gene variants, HLA-DQ2 or HLA-DQ8, increases the likelihood of developing the condition.
  • Family history: Individuals with a first-degree relative (parent, sibling, or child) with coeliac disease are at a higher risk.
  • Gluten consumption: The disease is activated by eating gluten, a protein found in wheat, barley, and rye, in genetically predisposed individuals.
  • Other autoimmune conditions: Coexisting autoimmune disorders, such as type 1 diabetes or autoimmune thyroid disease, heighten the risk of developing coeliac disease.
  • Environmental factors: Certain early-life infections or dietary factors, such as the timing and quantity of gluten introduction, may influence disease onset.

Diagnosis of Coeliac Disease

Blood tests

Tests such as tissue transglutaminase antibody (tTG-IgA) and endomysial antibody (EMA) are used to detect immune markers related to the condition. These tests are performed while the patient is on a gluten-containing diet, as the antibodies decrease with gluten avoidance.

Genetic testing

Testing for the HLA-DQ2 and HLA-DQ8 genes can identify genetic susceptibility. However, having these genes does not confirm the condition, as many people with these genes do not develop coeliac disease.

Endoscopy with biopsy

A thin, flexible tube with a camera examines the small intestine, and tissue samples are collected. These biopsies help identify villous atrophy, crypt hyperplasia, and inflammation, confirming coeliac disease when combined with other findings.

Capsule endoscopy

This involves swallowing a small camera capsule to capture images of the small intestine. It is typically used when traditional endoscopy is inconclusive or when other conditions are suspected.

Treatment Options

Managing coeliac disease focuses on dietary changes and addressing complications if they arise. Surgical treatment is not indicated in Coeliac disease.

Gluten-free Diet

Adopting a gluten-free diet is the primary and ongoing treatment for coeliac disease. This requires avoiding foods, drinks, and products containing wheat, barley, rye, and derivatives. Patients often benefit from working with a dietitian to ensure balanced nutrition and identify hidden sources of gluten in processed foods.

Nutritional Supplementation

Patients may need supplements such as iron, folate, calcium, vitamin D, and vitamin B12 to address deficiencies caused by malabsorption. Supplementation is tailored based on individual needs.

Medications

For severe cases or complications like refractory coeliac disease (when symptoms persist despite a gluten-free diet), corticosteroids or other immunosuppressive drugs may be prescribed to reduce inflammation.

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Prevention and Management

Coeliac disease cannot be prevented, but following a strict gluten-free diet is the most effective way to manage the condition and reduce the risk of complications. Regular check-ups are helpful for monitoring recovery, ensuring adherence to the diet, and addressing any new concerns.

Frequently Asked Questions

Can coeliac disease appear suddenly in adulthood?

Yes, the condition can manifest at any age, even after years of consuming gluten without noticeable issues. Environmental triggers or other factors may activate the disease later in life.

What happens if coeliac disease is left untreated?

Untreated coeliac disease can lead to serious complications, including malnutrition, osteoporosis, infertility, neurological conditions, and an increased risk of intestinal cancer.

Is cross-contamination with gluten a concern?

Yes, even small amounts of gluten, such as from cross-contaminated foods or surfaces, can cause symptoms and damage in individuals with coeliac disease. Careful preparation and labelling are necessary.

How long does it take to recover after starting a gluten-free diet?

Symptom improvement often begins within weeks, but complete healing of the intestinal lining may take months to years, depending on the severity of the initial damage and adherence to the diet.

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Dr Chong Choon Seng

MBBS (NUS)

MRCS (Edinburgh)

Masters in Medicine (Surgery)(NUS)

FRCS (Edinburgh)

Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 10 years of experience as a colorectal and general surgeon.

As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.

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