Coeliac Disease

Written by A/Prof Viraj Kariyawasam, Gastroenterologist

1. What is Coeliac Disease?

Coeliac disease is an autoimmune condition in which ingestion of gluten triggers an immune reaction that damages the lining of the small intestine. Gluten is a protein found in wheat, barley, and rye. Damage to the small bowel interferes with the absorption of nutrients and can lead to a wide range of symptoms and complications.

Coeliac disease affects people of all ages and is common in Australia. Many individuals remain undiagnosed because symptoms can be mild, non-specific, or occur outside the gastrointestinal tract.

2. Causes & Risk Factors

Coeliac disease occurs due to an abnormal immune response to gluten in genetically susceptible individuals. Specific genes (HLA-DQ2 and HLA-DQ8) are necessary for the disease to develop, but not everyone with these genes develops coeliac disease.

Risk factors include having a first-degree relative with coeliac disease, type 1 diabetes, autoimmune thyroid disease, Down syndrome, and other autoimmune conditions.

3. Symptoms & How It May Present

Symptoms of coeliac disease vary widely. Some people have classic digestive symptoms, while others present with non-digestive features.

Common symptoms include chronic diarrhoea, bloating, abdominal pain, weight loss, fatigue, iron deficiency anaemia, osteoporosis, mouth ulcers, headaches, and skin rashes. In children, poor growth or delayed puberty may occur.

4. How Is It Diagnosed?

Diagnosis requires blood tests and confirmation with small bowel biopsies. Blood tests measure specific antibodies associated with coeliac disease.

Gastroscopy with biopsies of the small intestine is usually required to confirm the diagnosis. It is essential that gluten is not removed from the diet before testing, as this can lead to false-negative results.

5. Treatment & Management Options

The only effective treatment for coeliac disease is a strict lifelong gluten-free diet. Even small amounts of gluten can cause ongoing intestinal damage, even if symptoms are mild or absent.

Management includes education, dietetic support, monitoring of nutritional deficiencies, and follow-up blood tests to assess response to treatment.

6. Living With / Managing Coeliac Disease

With strict adherence to a gluten-free diet, the intestine can heal and most symptoms improve or resolve.

Long-term follow-up is important to ensure nutritional adequacy, symptom control, and prevention of complications. Support from experienced dietitians and coeliac support organisations can be invaluable.

7. Prevention & Risk Reduction

There is currently no known way to prevent coeliac disease. Early diagnosis and strict adherence to a gluten-free diet significantly reduce the risk of complications.

8. When to Seek Medical Advice

Medical review is recommended for persistent gastrointestinal symptoms, unexplained iron deficiency, fatigue, osteoporosis, or a family history of coeliac disease.

People with diagnosed coeliac disease should seek review if symptoms recur, blood tests remain abnormal, or dietary adherence is difficult.