In Coeliac Disease the cells of the small bowel (intestine) are damaged. This causes the loss of the tiny, finger like projections, called villi, which line the inside of the normal bowel. The cells on normal villi are specialised so that they can break down and absorb nutrients in food. In Coeliac Disease these special cells are damaged and reduced in number. This leads to deficiencies in vitamins, iron, folic acid and calcium, because of the poor absorption of nutrients. Sugars, proteins and fats are often poorly absorbed as well.
Coeliacs are sensitive to gluten (the protein portion of wheat, rye, oats, barley, sorghum, triticale and some millets), which reacts with the small bowel lining, damaging it and causing loss of villi. The exact reason for this sensitivity and reaction to gluten is not known. Some believe Coeliacs are born with an enzyme deficiency (not yet identified) which causes abnormal breakdown of gluten and the accumulation of a toxic portion. Others think an abnormal immune body defense reaction to the "foreign" (non-human) gluten is responsible.
Between 10 and 15% of all first-degree relatives (parents, brothers, sisters or children) of known Coeliacs also hav e the disease. If one identical twin is affected, the other twin is virtually certain to be affected also. So Coeliac Disease certainly occurs in family groups and is probably inherited.
This varies in different countries and among different races. The incidence is high in Ireland, fairly frequent in England and Australia and lower in the USA. Although the exact frequency is not known, there are thousands of diagnosed Coeliacs in Australia.
Coeliacs remain sensitive to gluten throughout their life so, in this sense, they are never cured. However, after the removal of gluten from their diet, children and most adults return to being perfectly normal. Older patients often take longer to recover. Coeliacs will remain normal as long as they adhere to the diet.
The underlying abnormality is presumed to be present at birth, but recognisable problems cannot develop until gluten-containing solids are included in the infants diet. While damage to the bowel lining occurs whenever gluten is eaten, the effect on different Coeliacs varies markedly, making diagnosis very difficult. Some infants become rapidly and severely ill; other children develop problems slowly over two or three years. Many Coeliacs have few or no apparent problems during childhood, developing symptoms only during adult life. Family studies suggest that many Coeliacs in the community remain completely undetected.
Since other conditions can closely mimic Coeliac Disease, the correct diagnosis can only be made by showing that the bowel lining is definitely damaged. This can be very difficult once a gluten free diet has been started. Therefore the biopsy test should always be performed before starting a gluten-free diet. If anyone has a close relative with the condition or if they have been treated for iron deficiency anaemia on previous occasions, it is important to discuss the possibility of Coeliac Disease with their doctor.
Diagnosis relies upon proving that the small bowel lining shows the typical abnormality (damage) of Coeliac Disease. This can only be done by carrying out the small bowel biopsy test by one of two procedures: 1. A small capsule attached to a plastic tube is swallowed and allowed to pass into the upper small bowel (a low intensity x-ray machine checks the correct position). Gentle suction on the tube allows a tiny piece of bowel lining to be removed for testing. 2. Endoscopy, where a special optic fibre instrument is passed through the mouth with direct viewing of progress by the doctor, who is able to pass a small biopsy forceps through the instrument when it reaches the upper small bowel. Since this biopsy test is essential for proper diagnosis, referral to either an adult or child specialist gastroenterologist will usually be necessary. A blood test is available to aid the diagnosis of Coeliac Disease and to monitor the progress of treated patients. This gives doctors a simple and rapid test which can help decide which members of an affected family should have biopsies and can then be used in the subsequent management of known cases. The test may also help to reduce the incidence of delayed diagnosis.
Coeliac Disease is treated by a lifelong gluten-free diet. By specifically removing the cause of the disease, this treatment allows all abnormalities, including that of the bowel wall, to recover completely. As long as the diet is adhered to strictly, problems arising from the condition will not return. At the start of treatment it may be necessary to replace current deficiencies of nutrients (e.g. iron, folic acid and the fat-soluble vitamins A, D, E and K). An initial few weeks on a gluten-free diet which also has a low cow's milk content (to lower the lactose sugar intake) may be warranted. This will allow the bowel wall to recover and replace its normal quantity of the enzyme lactase, which splits or digests lactose sugar prior to absorption. In a small number of Coeliacs the enzyme lactase may slowly recover and the need for low or no cow's milk content in the diet may persist for some time.
The possibility of Coeliac Disease in other members of the family should be considered. Suspicious symptoms or signs in any close family member warrant a thorough "check-up". The small bowel biopsy will probably need repeating 3 to 12 months after starting the gluten-free diet. This is particularly important in young children because other causes of bowel wall damage similar to Coeliac Disease are more likely. In children, particularly, absolute certainty of the diagnosis requires proof that the recovered small bowel will redevelop damage when gluten's returned to the diet (this is called a "gluten challenge"). Proof of the disease by a "gluten challenge" biopsy removes all doubts about the absolute necessity of the lifelong gluten-free diet.
Although the diet is not difficult to manage, expert assistance and advice are needed initially. Any person beginning a glutenfree diet is strongly advised to do so only under the guidance of a qualified dietitian.
The dietitian can provide information about the frequent changes in ingredients of commercially manufactured goods and beverages as well as helping with dietary advice, including gluten-free recipes. Information about gluten-free diets can be obtained from: Qualified Dietitians (your doctor can give you a referral). The Coeliac Society of Australia - contact your State Branch. New laws regarding gluten content in foods will exist from 1994 - look for the new information on all gluten free labels.
If you are not sure of the gluten content on any food use the general rule - when in doubt, leave it out.
Adult Coeliacs, parents of Coeliac children and those with Dermatitis Herpetiformis are now banded together to form Coeliac Societies in all Australian States. If you would like to become a member or would like more information, please contact:
For more information, contact your State Coeliac Society:
|New South Wales:||02 411 4100|
|Queensland:||07 378 5747|
|South Australia:||08 266 3899|
|Victoria:||03 772 7086|
|Western Australia:||09 310 5371|
The Coeliac Society of Australia is not a medical organisation, advice is of a general nature only, and should not be relied upon.