Coeliac disease

Signs and symptoms

Each case of coeliac disease is different, but the following symptoms are common:

Digestive symptoms

• Bloated feeling and gas;
• Abdominal pain (stomach ache) and discomfort;
• Increase or decrease in appetite;
• Changes to bowel habits, causing diarrhea, constipation, or both, and;
• Greasy, foul-smelling stools that float.

Coeliac disease can cause abdominal bloating and pain. 

Malabsorption symptoms

With coeliac disease, your body is unable to absorb some vitamins, minerals and other nutrients. This lack of nutrients (malnutrition) in your system can lead to certain complications, such as:

• Tiredness and weakness;
• Unexplained weight loss;
• Mouth ulcers (sores);
• Anemia;
• Easily bleeding and/or bruising;
• Muscle cramping and joint pain;
• Increased risk of bone fractures (osteoporosis);
• Numbness, pain and tingling in your limbs;
• Hormone disorders, missed periods, infertility and impotence;
• Hair loss;
• Itchy, raised skin patches (dermatitis herpetiformis), usually on buttocks, knees, neck and face, and;
• Lactose intolerance - bloating and stomach pain after eating dairy products.

Children with coeliac disease may have additional symptoms, such as:

• Failure to grow at a normal rate (they may be smaller than their classmates);
• Late puberty;
• Weakened or discolored teeth;
• Depression, fussiness, irritability, or disturbed behavior, and;
• Difficulty concentrating or learning at school.

Methods for diagnosis

As coeliac disease symptoms often appear similar to those of other gastrointestinal disorders such as Crohn's disease, specific testing is required. A blood test alone is not enough to prove the presence of coeliac disease. A tissue biopsy is required for a definitive diagnosis.

Small intestine biopsy

This is usually done under light sedation and is a straightforward procedure. A thin, flexible, lit tube with a tiny camera (endoscope) at the end is inserted into the intestines via the mouth. The endoscope can take video, photos and tissue samples. A small sample of tissue is taken from the small intestine and sent for further testing to diagnose coeliac disease.

Small intestinal biopsy using an endoscope. 

Blood tests

Your doctor may order a range of blood tests to find out if your body is creating antibodies that are commonly seen in coeliac disease. In coeliac disease, antibodies are produced when you eat gluten, which in turn cause damage to your small intestine. You need to continue eating gluten while you are being tested, so your doctor can see if you are reacting to it.

Your doctor may also want to check:

• Iron and vitamin levels;
• Liver function;
• Electrolyte levels (mainly potassium, calcium and magnesium);
• Lipid (fat) studies to check how much cholesterol you are producing, and;
• Gene testing - this will check if you have the genes that make you more likely to develop coeliac disease. This can also be done by taking a painless swab from your cheek.

Stool examination

A stool test can check for undigested fats in your bowel movements, as this is a common finding in coeliac disease.

Types of treatment

Gluten-free diet

If you have coeliac disease, a lifelong gluten-free diet is the only current treatment option. Avoiding all foods, drinks and medications that contain rye, wheat and barley is key to avoiding gluten. Even if you are symptom-free for years, eating even a small amount of gluten can cause immediate painful cramping and diarrhea. It is very important to get a proper medical diagnosis before making any changes to your diet.

Many people with coeliac disease can tolerate oats as gluten-free versions are now available. A dietitian can help you discover where gluten is found in modern processed foods, and help you work out a suitable diet.

Medications

Medication is only used in severe cases of coeliac disease that have not responded to dietary changes. Corticosteroids, which reduce inflammation, may be given to you for a few months until your symptoms settle.

Potential complications

If left untreated, coeliac disease is associated with a wide range of complications:

Malnutrition

Being unable to absorb certain nutrients, minerals and fats can lead to malnutrition, even though you may be eating a healthy diet. You may feel tired all the time, feel cold and find it difficult to build muscles. Children with coeliac disease may have delayed development, stunted growth and weakened tooth enamel.

If your malnutrition causes vitamin deficiencies, your doctor may suggest that you take vitamin supplements. If your intestines are very inflamed, you may need vitamin injections. Common suggested supplements may be vitamins D, K and B12, iron, calcium and folate.

Osteoporosis

Due to a lack of calcium and vitamin D in your diet, you may develop osteoporosis, which can lead to a higher risk of fractures.

Cancer

There is a higher risk of developing bowel cancer and small intestine lymphoma if you do not follow a gluten-free diet. However, upon starting a gluten-free diet, this risk starts to decrease. You must always report any unusual bowel habits, such as bleeding, to your doctor.

Lactose intolerance

When you have coeliac disease, you may also have trouble digesting dairy products (lactose intolerance). You may experience cramping and diarrhea and feel generally unwell. It is advisable to avoid these products until your intestines have healed, then slowly reintroduce them.

Chronic inflammation

The inflammation caused by coeliac disease can sometimes affect other parts of your body, such as the joints, skin, liver, pancreas and the immune system.

Neurological (brain disorders)

There is a link between coeliac disease and developing some disorders of the nervous system, such as nerve damage and seizures.

Dermatitis (dermatitis herpetiformis)

Dermatitis, a non-contagious but distressing skin condition, is often seen with coeliac disease. This is most likely due to your body not absorbing all the essential nutrients your skin needs to be healthy.

Infertility

Coeliac disease may lead to problems with fertility or to repeated miscarriage.

Prognosis

Coeliac disease tends to start improving within days of starting a gluten-free diet. Your intestines slowly heal. In most adults, inflammation goes away within two years. In children the process can be much quicker, with recovery within 3-6 months and immediate symptoms disappearing within days. In general, if you stay away from gluten you can lead a relatively symptom-free life. With children who have coeliac disease, though, there may be long-term complications such as stunted growth or dental (tooth) damage.

Prevention

There is currently no way of preventing coeliac disease, but if you have close family members with this condition, it may be advisable to report any digestive system symptoms to your doctor. If you do have coeliac disease, the sooner you get a diagnosis, the better.