Coeliac disease is a chronic small intestine disease precipitated by dietary gluten in genetically predisposed individuals. Gluten is a protein occurring in certain grain foods - namely wheat, rye, barley, and oat. The disease is caused by an immune reaction triggered by exposure to gluten. This should not be confused with “gluten sensitivity” or gluten allergy. The disease may present with the “classic” features of malabsorption, but “atypical” coeliac disease is becoming more common.

Classical celiac disease

• Diarrhoea
• Steatorrhoea (fatty stools)
• Weight loss
• Nutritional deficiencies

Atypical celiac disease

• Iron deficiency anaemia
• Fatigue
• Abdominal bloating and discomfort
• Osteoporosis
• Infertility

Diagnosis

The diagnosis of coeliac disease depends on a combination of blood tests (serology) and histological findings (obtained by Gastroscopy). The diagnosis may be complicated by the removal of gluten from the diet prior to assessment by a physician. In this situation, it may be necessary to undergo a "gluten challenge", when dietary gluten is reintroduced in order to produce symptoms and positive investigations.

Treatment

The treatment of coeliac disease is a gluten free diet (GFD). There may be cross-reactivity with the protein components in rye and barley as well, and elimination of these from the diet is also important. Effective management requires consultation with a dietician, as many foods and other products contain gluten. Long-term management involves assessment of response to the diet and monitoring for nutritional deficiencies.