19th July 2023

Coeliac Disease

Coeliac disease is a chronic autoimmune systemic condition characterised by intolerance to gliadin in gluten and prolamins in wheat, barley and rye. Exposure to these allergens causes a pro-inflammatory response resulting in villous atrophy in the proximal small bowel mucosa, reducing its ability to perform its absorption functions. It can present in childhood following introduction of gluten into the diet or adulthood – this is now the most common timing of presentation, with the average age of diagnosis in the UK around 40 years old. Typical symptoms include abdominal pain, bloating, diarrhoea, weight loss, failure to thrive, fatigue, arthralgia and pallor. Clues within the presentation to suggest possible coeliac disease include anaemia (secondary to iron +/or B12 +/or folate deficiency), dermatitis herpetiformis (blistering skin rash on extensor sites), aphthous ulcers, buttock wasting or faltering growth. Patients will typically have raised IgA tissue transglutaminase antibodies (anti-tTGA) and IgA endomysial antibodies (anti-EMA IgA). These should be checked alongside total IgA levels, as those with IgA deficiency may get false negative results. The gold standard for diagnosis is endoscopy with small intestine biopsies – this requires continued gluten-containing diet for at least 6 weeks prior to endoscopy. Eliminating gluten from the diet is the mainstay of treatment. Those diagnosed with dermatitis herpetiformis should be offered dapsone. Complications include mineral deficiencies – namely calcium, B12, folate, iron, vitamin D, osteoporosis, hyposplenism and small bowel lymphoma.