Medical student Yimeng Zhang explains that coeliac disease is a ‘multisystem disorder’, not only affecting the intestine but any part of the body, including the skin.
Coeliac disease is a common digestive condition where a person’s body has an adverse reaction to gluten. It is a condition that affects approximately one in 100 people in the European population. However, only 24 per cent of people who have the condition have been diagnosed. It more commonly affects women and frequently develops during early childhood or later in adulthood between 40 to 60 years of age, but can occur at any time.
A misconception is that coeliac disease is an allergy to gluten. It is actually an autoimmune condition. This happens when the body’s defence against infection mistakenly attacks the body’s own tissues or other harmless substances.
In coeliac disease, the immune system attacks one of the substances which makes up gluten called gliadin, thinking it is a threat to the body. This then damages the surface of the small bowel, causing inflammation and therefore making it red and swollen.
The lining of the small intestine contains millions of tiny finger-like structures called ‘villi’. These improve the efficacy of digestion and absorption of food and nutrients. However, in people with coeliac disease, the villi become flattened as a result of the inflammation. As the small intestine is the area where most nutrients are absorbed by the body, damage to the area means that food and nutrients are not as efficiently absorbed.
One can lead a completely normal life by switching to a gluten-free diet in order to control the symptoms and prevent any long-term consequences
Exactly what causes the immune system to act in this way is still not entirely clear, although a combination of a person’s genetic make-up and the environment have been shown to play a part in causing coeliac disease.
Gluten is a protein which is found in three types of cereal: wheat, barley and rye. These are found in many foods such as pasta, cakes, breakfast cereals, most bread and beers.
Eating these types of foods can trigger symptoms of coeliac disease, which can range from mild to severe.
Examples of what people may experience are:
• Diarrhoea
• Bloating and flatulence
• Abdominal pain
• Weight loss
• Tingling and numbness in your hands and feet
• Feeling tired all the time as a results of malnutrition (not getting enough nutrients from the food)
• Swelling of hands and feet due to a build-up of fluid
• Hair loss
• Anaemia
• Children who get it may not grow and develop at the expected rate.
People with the condition do not necessarily experience intestinal symptoms. Coeliac disease is known as a ‘multisystem’ disorder, that is, symptoms can affect any area of the body.
Symptoms differ between individuals, both in terms of type and severity.
If one puts off seeking medical help, or if one is diagnosed with coeliac disease and continues to eat gluten, complications may be experienced.
These include osteoporosis (weakening of the bones, which means they are more easily broken), severe problems with the digestive system, problems affecting pregnancy and also some forms of cancer.
Dermatitis herpetiformis is the skin manifestation of coeliac disease. It presents itself as a rash which commonly occurs at the elbows, knees, shoulders, buttocks as well as on the face; with red, raised patches, often with blisters. This occurs because the immune system produces antibodies in response to the gluten that was consumed, and these antibodies enter the bloodstream and collect in the small blood vessels just under the skin. This triggers a further immune reaction which results in the rash.
Coeliac disease is diagnosed with a blood test and tissue sample from the inside lining of the small intestine. There is no cure for this condition. However, one can lead a completely normal life by switching to a gluten-free diet in order to control the symptoms and prevent any long-term consequences. Even a small amount of gluten can cause an immune reaction in very sensitive people. Removing gluten from the diet allows time for the gut to heal.
Coeliac disease is a lifelong condition and people who have it need a lot of support. If you suspect that you may have coeliac disease, speak to your family doctor for help and advice before making any dietary changes.
How coeliac disease affects the intestine
