Coeliac disease is characterised by the immune system reacting to the consumption of gluten, which is a type of protein found in wheat, barley, and rye. For patients with this condition, gluten triggers a response in the small intestine specifically. Over time, this can damage the lining of the small intestine, leading to malabsorption of key nutrients. The aforementioned damage can lead to symptoms such as diarrhoea, weight loss, fatigue, anaemia, and bloating, which are often the first signs of the condition. In children, malabsorption of nutrients results in serious consequences, including stunted growth and development, in addition to other symptoms.
Whilst it has been difficult for researchers to arrive at specific causes for this condition, the medical evidence shows that an individual’s genetics, combined with environmental and psychological factors, leads to the development of this condition.
Among the factors that may contribute to the onset of coeliac disease - breastfeeding, prior gastrointestinal infections, certain gut bacteria, particular surgeries, pregnancy, childbirth, viral infections and even severe emotional distress have been identified as contributors.
Similar to other gastroenterological conditions, there are several risk factors for this condition. These include:
Family history is a significant risk factor given that this disease can be passed genetically. The closer the relative with coeliac disease, the higher the risk. It has been shown that people with first-degree relative with coeliac disease have a 10 to 15% risk of developing the condition themselves.
Certain alterations in the genetic code, known as polymorphisms, have been associated with the development of coeliac disease.
It is believed that coeliac disease can develop following a past infection during early childhood, such as the rotavirus for example, in individuals with a genetic predisposition for the condition.
It may also be likely that babies who consume gluten before they are 3 months of age may be at increased risk. Certain experts recommend that parents wait until a child is 6 months before being given food containing gluten. There is also evidence that babies may develop this condition if they are not being breastfed when gluten is added to their diets.
Certain medical conditions like Type 1 diabetes, Down syndrome, Turner syndrome, autoimmune thyroid disease, microscopic colitis, ulcerative colitis, epilepsy, and Addison’s disease, are associated with the concomitant development of coeliac disease.
Given that there is no cure for this condition, individuals need to maintain a strict, life-long gluten-free diet. This diet must not contain items such as barley, semolina, triticale, malt, rye and other types of wheat and flour.
In addition to these items, gluten may be incorporated in certain other food items, preservatives, supplements, toothpaste and mouthwash, and even certain lipsticks. In light of this, individuals must be discerning about the food and products they add to their lifestyle.
Apart from dietary restrictions, incorporating vitamin and mineral supplements are also required if a patient’s anaemia or nutritional deficiencies are pronounced. Commonly utilised supplements include copper, iron, folate, certain vitamins and Zinc.
Apart from dietary modifications, medication may be used to control intestinal inflammation. For patients with severe small intestinal damage or refractory coeliac disease, a course of steroids may be recommended. This type of medication can ease serious symptoms associated with this condition via a reduction in inflammation.
This form of dermatological condition, which presents as a type of skin rash, is common amongst patients with coeliac disease. Prescription medication, along with a strict gluten-free diet, will need to be maintained to treat this dermatological condition.
For those with refractory disease, the small intestine may never heal. Because of this, specialised treatment and medical attention are necessary.
Coeliac disease is a lifelong condition that requires careful management. To do so, patients need ongoing guidance and support. Dr Suhirdan Vivekanandarajah is an experienced interventional gastroenterologist and hepatologist in Sydney. Patients can receive further information and treatment for this condition by booking an appointment with Dr Vivekanandarajah.
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