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Biopsy of Small Bowel showing coeliac disease manifested by blunting of Villi , crypt hyperplasia, and Lymphocyte infiltration of crypts
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or '''celiac disease''' is an
Autoimmune disorder of the
Small Bowel that occurs in
Genetically Predisposed individuals in all age groups after early infancy. Symptoms may include chronic
Diarrhoea ,
Failure To Thrive (in children) and
Fatigue , but these may be absent and associated symptoms in all other organ systems have been described. It affects approximately 1% of
Indo-European populations, though it is significantly underdiagnosed. A growing portion of diagnoses are being made in asymptomatic persons as a result of increasing screening.
1
Coeliac disease is caused by a reaction to
Gliadin , a
Gluten protein found in
Wheat (and similar proteins of the
Tribe Triticeae which includes other cultivars such as
Barley and
Rye ). Upon exposure to gliadin, the enzyme
Tissue Transglutaminase modifies the protein, and the
Immune System cross-reacts with the bowel tissue, causing an
Inflammatory Reaction . That leads to flattening of the lining of the small intestine, which
Interferes With The Absorption of nutrients. The only effective treatment is a lifelong
Gluten-free Diet .
This condition has several other names, including: (with
Ligature ), '''c(o)eliac sprue''', '''non-tropical sprue''', '''endemic sprue''', '''gluten enteropathy''' or '''gluten-sensitive enteropathy''', and '''gluten intolerance'''. The term ''coeliac'' derives from the
Greek κοιλιακος (''koiliakos'', abdominal), and was introduced in the 19th century in a translation of what is generally regarded as an ancient Greek description of the disease by
Aretaeus Of Cappadocia .
2 See also
Google Books entry
Classic symptoms of coeliac disease include
Diarrhoea ,
Weight Loss (or stunted growth in children), and
Fatigue , but while coeliac disease is primarily a bowel disease, bowel symptoms may also be limited or even absent. Some patients are diagnosed with symptoms related to the decreased absorption of nutrients or with various symptoms which, although statistically linked, have no clear relationship with the malfunctioning bowel. Given this wide range of possible symptoms, the classic triad is no longer a requirement for diagnosis.
Children between 9 and 24 months tend to present with bowel symptoms and growth problems shortly after first exposure to gluten-containing products. Older children may have more malabsorption-related problems and psychosocial problems, while adults generally have malabsorptive problems.
3 Many adults with subtle disease only have fatigue or
Anaemia .
The
Diarrhoea characteristic of coeliac disease is
Pale , voluminous and malodorous.
Abdominal Pain and cramping, bloatedness with abdominal distention (thought to be due to fermentative production of bowel gas) and
Mouth Ulcer s
4 may be present. As the bowel becomes more damaged, a degree of
Lactose Intolerance may develop. However, the variety of gastrointestinal symptoms that may be present in patients with coeliac disease is great, and some may have a normal bowel habit or even tend towards
Constipation . Frequently the symptoms are ascribed to
Irritable Bowel Syndrome (IBS), only later to be recognised as coeliac disease; a small proportion of patients with symptoms of IBS have underlying coeliac disease, and screening may be justified.
5
Coeliac disease leads to an increased risk of both
Adenocarcinoma and
Lymphoma of the small bowel, which returns to baseline with diet. Longstanding disease may lead to other complications, such as ''ulcerative jejunitis'' (ulcer formation of the small bowel) and stricturing (narrowing as a result of scarring).
6
The changes in the bowel make it less able to absorb nutrients, minerals and the fat-soluble vitamins A, D, E, and K.
Coeliac disease has been linked with a number of conditions. In many cases it is unclear whether the gluten-induced bowel disease is a causative factor or whether these conditions share a common predisposition.
