Introduction 

Have you ever experienced persistent digestive discomfort or unexplained fatigue that lingers no matter what you do? Consider this – what if these symptoms aren't just passing irritations, but signs of a long-term condition silently disrupting how well your body works? 

Coeliac disease, known as celiac disease in various parts of the world, is an autoimmune disease (i.e. when your body’s immune system overreacts, by mistakenly attacking its cells leading to health problems) triggered by gluten consumption.¹

Gluten, a protein frequently found in foods such as cereal, is a fundamental ingredient for the human body, essential for growth and tissue repair. This protein is found in sources such as wheat, barley, rye, and oats and is also present in food items like pasta, cakes, bread and sauces. 

Coeliac disease leads to stomach problems like bloating and diarrhoea to chronic fatigue and even neurological symptoms. This article will primarily explore the causes and symptoms of coeliac disease, and its diagnosis and treatment.   

Understanding coeliac disease 

• Coeliac disease is a chronic condition in which the body reacts improperly to gluten, triggering an inappropriate immune response leading to inflammation and harm to the small intestine. It can result in the body’s inability to absorb essential nutrients, causing disruption
• In coeliac disease, an enzyme called tissue transglutaminase aids in repair. However, the immune system mistakenly produces antibodies that target and attack these enzymes (tissue transglutaminase) crucial for repair. This attack results in inflammation and damage to the small intestine
• Studies indicate many individuals with coeliac disease go undiagnosed due to inadequate testing for the condition. This oversight occurs because the symptoms of coeliac disease vary widely among individuals and there is limited awareness of the condition 

Prevalence statistics

• Coeliac disease is one of the most prevalent autoimmune disorders, affecting approximately 0.5-1% of the general population.²
• In the UK and Europe, coeliac disease impacts at least 1 out of every 100 individuals, yet only 36% of those affected receive clinical diagnosis
• On average, adults with coeliac disease typically experience a lengthy delay of 13 years from when symptoms first appear to receive a diagnosis of coeliac disease.³

Causes of coeliac disease 

Coeliac disease may develop due to genetic predisposition, environmental triggers and potentially other associated disorders.⁴

Genetic factors 

HLA-DQ2 and HLA-DQ8 genes 

• Coeliac disease is linked strongly to the inheritance of specific genes, known as HLA-DQ2 and HLA-DQ8, which increase susceptibility to gluten intolerance 
• Individuals with these genetic markers are more likely to develop coeliac disease because these genes influence how the immune system responds to gluten  
• When an individual with these genetic markers consumes gluten, their immune system can respond inappropriately, leading to an adverse reaction where the body’s immune system attacks its healthy cells

Environmental triggers 

Gluten consumption 

• Gluten acts as a primary trigger for coeliac disease
• Gluten emerged roughly around 10,000 years ago as people began farming and living in communities 
• Gluten-containing grains, a relatively recent addition to the human diet, are consumed in large quantities and contain proteins that resist digestion 
• Giladins, a key component of gluten, are particularly challenging for intestinal enzymes. It breaks down and triggers an immune response

Early introduction of gluten in infancy 

• When individuals with genetic susceptibility consume gluten-containing foods, an immune response damages the small intestine over time
• Coeliac disease typically starts to develop in children who have a genetic risk before they turn five years of age ⁶
• Introducing gluten to an infant’s diet before their immune system is fully developed may increase the risk of coeliac disease in genetically susceptible individuals 
• Delaying gluten introduction until the infant is six months old, is recommended to reduce the risk of coeliac disease ⁷
• Research studies have shown that understanding how early diet, genetics and other factors affect the risk of coeliac disease is very complicated ⁸

Gut microbiota 

• Studies have shown that the bacteria in our gut (gut microbiota) can impact how well we digest gluten, how our intestine functions and how our immune system responds. However, further studies are needed to understand the interplay between gut microbiota and coeliac disease fully 

Other disorders 

• Other disorders can be associated with an increased prevalence of coeliac disease and predispose individuals to develop it 
• There is a greater risk of developing coeliac disease in individuals with type 1 diabetes, Down syndrome, Turner syndrome, Williams syndrome, and autoimmune thyroid disease (hypothyroidism or hyperthyroidism), which may coexist with coeliac disease 

Symptoms of coeliac disease 

The following symptoms of coeliac disease are:⁵ 

• Gastrointestinal symptoms linked to the digestive system
• Non-gastrointestinal symptoms are symptoms linked to other parts of the body or systems 

Gastrointestinal symptoms

• Diarrhoea
• Malabsorption 
• Bloating and gas
• Abdominal Pain
• Vomiting 
• Weight loss 

Non-gastrointestinal symptoms

• Fatigue
• Anaemia
• Itchy rash (dermatitis herpetiformis)
• Neurological symptoms:
  • Nerve damage (peripheral neuropathy)
  • Difficulty with coordination (ataxia)
  • Seizures/epilepsy 
  • Migraines
• Chronic fatigue
• Joint pain/inflammation
• Depression
• Weak, brittle bones/ low bone density (osteoporosis/osteopenia)
• Infertility 
• Vitamin deficiencies (e.g., vitamin B12 deficiency)
• Delayed puberty
• Dental enamel defects
• Autoimmune disorders

Recognising the symptoms of coeliac disease is crucial for prompt diagnosis,  treatment, and prevention of long-term health complications. 

Diagnosis of coeliac disease 

• Your GP can arrange blood tests to detect antibodies indicative of coeliac disease. If positive, you may then be referred to a specialist for further testing. You may also be referred if you display signs of coeliac disease despite having no indicative antibodies in your blood test
• A gastroenterologist may advise an intestinal biopsy
• Genetic testing to identify genetic patterns which are associated with an increased risk of developing coeliac disease⁴

Treatment and management 

• Gluten-free diet – management of coeliac disease involves committing to a lifelong gluten-free diet, with avoidance of foods that contain wheat, rye, and barley. A dietician assists in adopting a gluten-free diet
• Nutritional supplements – the management of nutritional deficiencies in coeliac disease treatment involves supplementing individuals with iron, zinc, calcium, fat-soluble vitamins and folic acid
• Follow-up care – individuals with coeliac disease may undergo follow-up management, which might involve addressing side effects (e.g., dermatitis herpetiformis, osteoporosis), determining their responsiveness to a gluten-free diet or identifying any other associated conditions.⁵

Complications of untreated coeliac disease 

Untreated coeliac disease may result in various complications, such as malabsorption, malnutrition and development of lactose intolerance. Additionally, there is an increased risk of osteoporosis, cancer (e.g., bowel cancer) and other autoimmune diseases when coeliac disease is untreated.⁴

FAQs

What happens if coeliac disease is left untreated?

If left untreated, coeliac disease causes chronic inflammation. It leads to other food intolerances. It damages the inner lining of the intestine which is not able to absorb nutrients and leads to malnourishment.

What does gluten-free mean?

It means that either the product has no gluten or it is processed to the extent of reducing gluten to 20 ppm (parts per million).

What is gluten?

Gluten is the general name of proteins found in wheat, barley, and rice. Gluten helps food maintain its shape, it acts as a glue that holds food together.

Which foods are gluten-free? 

They are fruits, vegetables, beans, legumes, dairy, fish, poultry, meat, seafood, corn, buckwheat, millet, quinoa, tapioca, and rice. (The list may be longer.)

Summary 

• Coeliac disease arises when an individual consumes gluten, which triggers environmental factors or inherited genetic predispositions
• It can lead to a range of digestive symptoms such as diarrhoea, malabsorption, bloating, and gas, as well as non-digestive symptoms like fatigue, anaemia, and an itchy rash known as dermatitis herpetiformis
• Early detection, diagnosis, and treatment of coeliac disease are crucial because they help prevent serious problems and complications
• Understanding the causes and symptoms of coeliac disease is vital for early detection and effective management