What is Coeliac Disease?
In people with coeliac disease the immune system reacts abnormally to gluten (a protein found in wheat, rye, barley and oats), causing small bowel damage. The tiny, finger-like projections which line the bowel (villi) become inflamed and flattened. This is referred to as villous atrophy. The surface area of the bowel available for nutrient absorption is markedly reduced which can lead to various gastrointestinal and malabsorptive symptoms.
A number of serious health consequences can result if the condition is not diagnosed and treated properly.
Who gets Coeliac Disease?
You must be born with the genetic predisposition to develop coeliac disease. The most important genes associated with susceptibility to coeliac disease are HLA DQ2 and HLA DQ8. Either one or both of these genes are present in virtually every person with coeliac disease. Only 1 in 30 people (approximately) with one or both genes will get coeliac disease.
Environmental factors play an important role in triggering coeliac disease in infancy, childhood or later in life.
How Common is the Condition?
Coeliac disease affects approximately 1 in 100 Australians. However 75% currently remain undiagnosed. This means that approximately 160,000 Australians have coeliac disease but don’t yet know it.
Can Coeliac Disease be Cured?
People with coeliac disease remain sensitive to gluten throughout their life, so in this sense they are never cured. However a gluten free diet does allow the condition to be managed effectively. A lifelong gluten free diet is the only recognised treatment for coeliac disease. By removing the cause of the disease, a gluten free diet allows the small bowel lining to heal and symptoms to resolve. As long as the gluten free diet is strictly adhered to, problems arising from coeliac disease should not return.
There is no correlation between symptoms and bowel damage, so even if asymptomatic (you have no symptoms), damage to the small bowel can still occur if gluten is ingested.
People with coeliac disease should remain otherwise healthy as long as they adhere to a diet free of gluten. Relapse occurs if gluten is reintroduced.
What are the Long Term Risks of Undiagnosed Coeliac Disease?
The long term consequences of coeliac disease are related to poor nutrition and malabsorption of nutrients. Untreated, coeliac disease can lead to chronic poor health, osteoporosis, infertility, miscarriage, depression and dental enamel defects. There is also a small, but real, increased risk of certain forms of cancer such as lymphoma of the small bowel. In children, undiagnosed coeliac disease can cause lack of proper development, short stature and behavioural problems.
Fortunately, timely diagnosis of coeliac disease and treatment with a gluten free diet can prevent or reverse many of these problems.