What do you know about Coeliac Disease?

Coeliac disease is a lifelong disease present from infancy but which is most often not diagnosed until adult life.  It generally presents with a variety of gastrointestinal symptoms such as diarrhoea, bloating, flatulence, abdominal pain and weight loss, but may also present with a number of non-gastrointestinal abnormalities (eg abnormal liver function tests, iron deficiency anaemia, bone disease, skin rash).  In some individuals there may be no symptoms at all.  In the longer term a number of more serious problems may occur as a result of ongoing small intestinal inflammation, including lymphoma of the intestine.  The disease affects up to 2% of the New Zealand population and there has been a substantial increase in its prevalence over the last 50 years, and an increasing rate of diagnosis in recent years due to a greater awareness of the condition and more reliable diagnostic tests.

The symptoms are due to an immune reaction to dietary gluten (storage protein for wheat, barley and rye) that primarily affects the small intestine in those with a genetic predisposition.  Exclusion of gluten from the diet can be expected to reduce, but not necessarily eliminate such symptoms.  The treatment for coeliac disease currently involves lifelong adherence to a strict gluten free diet (GFD), which requires significant patient education, motivation, expense and follow-up.  Unfortunately following a GFD does not always eliminate symptoms because of tiny amounts of gluten which may still exist in the diet.  Persistent or recurring symptoms should lead to a review of the GFD to ensure the diet is truly gluten free.  If blood testing confirms adherence with the GFD then an alternative cause for these symptoms may need to be considered.

Newer therapeutic modalities are being studied in clinical trials but are not yet approved for standard practice.  Given the incomplete response of many patients to a GFD as well as the difficulty of adherence to the diet over the long term, development of new effective therapies for symptom control and particularly reversal of inflammation and small intestinal damage are certainly needed.