Coeliac disease

Coeliac disease is an auto-immune disorder of the small intestine that occurs in genetically predisposed people, and is the result of the consumption of gluten. Gluten is a protein that is found in many cereals, especially in wheat, rye and barley. Symptoms of the disease include chronic diarrhoea and flatulence. The disease can also develop in adulthood, when it causes not only intestinal symptoms, but also a number of other health problems.

The prevalence of the disease in Europe and the U.S. is now estimated to be 1 of 100 to 1 of 200 inhabitants. This means that Coeliac disease is one of the most prevalent chronic diseases in general. Coeliac disease is not just a disease that occurs in children, but in different clinical forms affects people of all ages.

Coeliac disease most often begins with diarrhoea in childhood, resulting in stunted growth. The disease can also occur in adulthood, when usually extra intestinal signs of the disease occur. Inadequately treated coeliac disease can cause complications with many other parts of body.

The most common is anaemia due to a lack of iron, folic acid or vitamin B12. Another unpleasant problem is osteoporosis, which typically occurs with adults. There are also other problems connected with the disease, such as inflammation of the joints, enamel defect and inflammation of the skin. It may also affect the reproductive system. Puberty delays have been shown in girls and boys with untreated coeliac disease, while there are also other frequent problems, particularly infertility, irregular menstruation and abortions. Liver function is often impaired in elderly patients with coeliac disease, but it can be treated with the proper diet.

It has been known for a long time now that in patients with untreated coeliac disease neurological complications are more prevalent, such as balance disorder and epileptic seizures. The most serious complication caused by the disease is undoubtedly the development of various malignancies, especially the small bowel malignant lymphoma.

Disease diagnosis

Today, the diagnosis is still based on the intestinal mucous membrane biopsy. However, immunological examinations also have an important role in setting the diagnosis by establishing the presence of antibodies in the blood (AMA, EMA, t-TG). 

Treatment

The disease cannot be cured with medications. The only effective therapy is the gluten-free diet. The patient must exclude all gluten-containing foods from their diet. The gluten-free diet should be life-long. This diet allows the mucosa and the villi of the small intestine to recover, and the body can absorb and use the nutrients and regain the lost weight. The diet, however, does not prevent the appearance of certain coeliac disease-associated autoimmune diseases such as the autoimmune thyroiditis.

One should not eat cereals and food products made of wheat, rye, barley and oats. Coeliac patients should not eat flour, semolina, bread, breadcrumbs, biscuits, pasta, noodles (containing wheat, barley or rye), cakes and similar foods. Patients must take great care regarding the ingredients of other food products as well for they may contain supplements of wheat origin (various emulsifiers, stabilisers and preservatives).

Special gluten-free flour, gluten-free bread, pasta and other gluten-free products exist as a substitute for wheat flour. When shopping, one must necessarily look at the product labels to study all the ingredients. The product label should inform about the exact ingredients of the product. Identifying gluten-free products is nowadays easier due to the EU regulations that require manufacturers to declare the possible presence of gluten. In some products there is a possibility of gluten contamination during the production process (dried meat products, soya sauces, sweets, ice-cream, meat preparations and other processed foods). Thus, patients should not consume such type of food unless they are absolutely certain that they are gluten-free.

Gluten-free products can be bought in specialised grocery stores, in diet sections of the supermarkets partly also in pharmacies. The products for patients can easily be identified by a crossed-out ear of wheat logo on the package, a symbol that guarantees the absence of gluten.

Exclusion of all cereal based food products can result in a reduced intake of plant fibres. This can be avoided by regular consumption of fruits and vegetables. Patients should also consume enough vitamins, especially the B-complex vitamins, as well as foods containing calcium and iron.

Gluten-free food products allowed in the diet of coeliac patients are: cereals (rice, corn, buckwheat, millets), potato, chestnut, vegetables, fruits, milk, eggs, meat, fish, honey, sugar, vegetable oils.

Various experimental drugs are in the development phase but they are not expected to become available for general use in the near future. With the use of genetic engineering, minimally-immunogenic wheat types may be developed. In addition, by employing a combination of enzymes (propyl endopeptidase and glutamine-specific cysteine endopeptidase), gluten breakdown in duodenum could be facilitated. In this way, Coeliac patients would be able to consume gluten-containing food as well. Furthermore, it is being researched how to reduce the influence of gluten on the immune system by inhibiting zonulin, which is an intestinal signalling protein, connected with an altered intestinal wall permeability.

The aim of the treatment is to enable patients to shake off the burden of the gluten-free diet, but the mentioned treatment modalities are still in the trial phase. To be useful to patients, any new treatment option will have to satisfy the requirements of reliability, safety and efficacy; this, however, is not expected in the next few years. A strict gluten-free diet thus remains the core of prevention and therapy.