Coeliac Disease
What is coeliac disease?
Coeliac disease is a common, autoimmune condition where the ingestion of gluten (a protein found in wheat, barley, and rye) leads to damage in the lining of the small intestine. In genetically predisposed individuals, gluten triggers an immune response that attacks the villi, the small finger-like projections that line the small bowel and absorb nutrients.
Symptoms and signs
Symptoms are highly varied and can affect any body system. They range from classic gut symptoms to non-gastrointestinal manifestations:
Gastrointestinal symptoms: Chronic diarrhoea, abdominal pain, bloating, excessive gas and weight loss
Systemic symptoms and signs: Fatigue, iron deficiency anaemia, vitamin and mineral deficiencies (e.g., Vitamin D, B12), bone density loss (osteoporosis), and skin rash (dermatitis herpetiformis).
How is coeliac disease diagnosed and investigated?
Accurate diagnosis is crucial and requires the patient to be consuming gluten at the time of testing:
Blood tests: Screening involves checking for specific coeliac antibodies
Genetic testing: May be used to exclude the diagnosis, as the disease cannot develop without the necessary genes (HLA-DQ2 or HLA-DQ8).
Gastroscopy (upper endoscopy) with biopsies: This is the gold standard for confirmation of the diagnosis. Biopsies are taken from the duodenum (the first part of the small intestine) to look for the characteristic villous atrophy (flattening) caused by the disease.
Treatment and management of coeliac disease
The only effective treatment for coeliac disease is a strict, lifelong, gluten-free diet (GFD).
Gluten-free diet (GFD): Complete avoidance of wheat, barley, and rye. This allows the small intestine lining to heal, symptoms to resolve, and nutrient absorption to normalise.
Nutritional supplementation: Management of any underlying deficiencies (e.g., iron, B12, calcium) is essential.
Monitoring: Regular follow-up with a gastroenterologist and dietitian is important to monitor adherence, screen for complications, and ensure recovery of the small bowel lining.
Get expert, multidisciplinary care for coeliac disease
Dr Shane Selvanderan provides expert diagnosis and ongoing management of coeliac disease, ensuring patients receive the necessary support, including endoscopy and biopsy, to confirm the diagnosis. He also works closely with specialist dieticians to help guide the transition to a healthy, gluten-free lifestyle.