Fact Files : What is Coeliac Disease?

Coeliac Disease is caused by an immune reaction to gluten, a protein found in wheat, rye, barley, triticale and oats. In Coeliac Disease, the cells of the small bowel (intestine) are damaged. This causes a flattening of the tiny, finger like projections called villi which line the inside of the bowel.

View of Villi in the Bowel
Normal Villi	Villi in person with untreated Coeliac Disease

The function of the cells on normal villi is to break down and absorb nutrients in food. In Coeliac Disease these cells become flat and inflamed causing decreased absorption of nutrients and minerals from food. This leads to deficiencies in vitamins, iron, folic acid and calcium. Sugars, proteins and fats are often poorly absorbed as well.

CAUSE

The cause is not known. However, it is thought that people with Coeliac Disease have an immune system which perceives gluten to be ‘foreign’ and reacts by initiating an immune response that causes damage to the lining of the small intestine. Both genetic and environmental factors are though to play a role with Coeliac Disease as it can occur at any age.

DIAGNOSIS

Diagnosis requires microscopic examination of a small bowel biopsy in order to demonstrate that the villi are damaged. This involves a gastroscopy (passing a tube from the mouth into the gut) to sample the wall of the small intestine. A blood test for characteristic anti-gliadin antibodies only, is not sufficient. It is important to have the biopsy before commencing a gluten free diet to ensure a definite diagnosis. To confirm a diagnosis, the biopsy should be repeated after 6-12 months of commencing a gluten free diet, to demonstrate improvement to the villi.

TREATMENT

The only treatment for Coeliac Disease is the lifelong adherence to gluten-free diet. When gluten is removed from the diet, the small intestine will start to heal and overall health improves. Even small amounts of gluten can cause some damage to the lining of the small intestine without any obvious symptoms. There is no agreement amongst doctors, scientists and dietitians as to what (if any) is a safe level of gluten in the diet for someone with coeliac disease, The Coeliac Society of Australia Inc believes that gluten should be entirely removed, but individuals should consult their dietitian or doctor.

LONG TERM RISKS

The long term risks of undiagnosed Coeliac Disease or non-adherence to the gluten-free diet include:-

• chronic poor health
• miscarriages
• osteoporosis due to calcium malabsorption
• depression
• infertility
• dental enamel defects
• lymphoma
• risk of gastrointestinal & oesophageal carcinoma

It is sensible to have your blood checked annually for iron and folic acid levels, and to have a bone mineral density test performed at approximately 5 year intervals.

Back to Fact File Index