Medical student Annalise Bellizzi details the various conditions associated with coeliac disease: from lactose intolerance and anaemia to thyroid disease and infertility.
Coeliac disease, a common digestive condition, is estimated to affect one in 100 people worldwide. Many mistakenly think that coeliac disease concerns an allergy or intolerance to gluten in food, however, this is a common misconception.
Coeliac disease is an autoimmune condition, which means that the body’s natural system that fights disease is mistakenly ‘attacking’ healthy tissue. Usually, patients suffer from diarrhoea, abdominal pain, loss of weight or lack of weight gain.
The consumption of gluten by coeliac sufferers triggers his or her immune system to attack their small intestine, because it mistakes substances found inside gluten as being a threat to the body and so attacks them.
Gluten is a protein found in wheat, barley, rye and oats, and is found in any food that contains these cereals, such as pasta, cakes, breakfast cereals and beer that has been made from barley.
The inner lining of the small intestine is covered with small finger-like projections called villi to enhance absorption. The immune system’s attacks result in damage to these villi and, as a result, nutrients cannot be properly absorbed into the body.
Furthermore, there are various conditions associated with coeliac disease. There are three main factors contributing to the onset of these related conditions.
The first of these is a matter of simple genetics: the genes that a person inherits that make him susceptible to coeliac disease may also make the individual susceptible to a range of other immune conditions.
Despite the many conditions associated with coeliac disease, it does not mean that every person with coeliac disease will develop one of these conditions
The second factor is chronic inflammation. Coeliac disease causes chronic inflammation, mostly affecting the small intestine’s lining, but not only. Other organs that may be affected, including the skin, joint, bone, liver, thyroid gland, nervous system and reproductive tract.
Coeliac sufferers are also often at risk of vitamin deficiencies, resulting from poor absorption of nutrients (vitamins and minerals), including iron and vitamin B12.
Undiagnosed and untreated coeliac disease can result in the development of osteoporosis, which is a condition that causes the bones to become thin and brittle. This would occur as a result of poor absorption of minerals necessary for healthy bones such as calcium for a certain period of time.
Coeliac disease has also been associated with lactose intolerance. This is because the part of the gut that produces lactase – the enzyme involved in breaking down lactose – is damaged in coeliac disease.
Serious complications resulting from coeliac disease include lymphoma and small bowel cancer. However, the risk of developing these specific types of cancers returns to normal if the coeliac sufferer would have been following a gluten-free diet for three to five years.
If undiagnosed or untreated, coeliac disease may be the underlying cause of unexplained infertility. However, in women following a gluten-free diet, there is no extra risk of infertility problems.
Due to the lack of iron absorption, anaemia is very commonly associated with undiagnosed coeliac disease. In fact, persons having unexplained anaemia should be screened for coeliac disease. Although handling anaemia takes time and dedication to a balanced and nutritious diet, it has been shown to improve greatly on a gluten-free diet.
Due to their common genetic predisposition, patients with coeliac disease are four times more at risk than the general population to also have autoimmune thyroid disease. Thyroid disease is a general term referring to anything that is wrong with the thyroid gland.
Thyroid conditions or diseases can include hypothyroidism, where the body uses up energy slower than it should, or hyperthyroidism, where on the contrary the body uses up energy faster than it should. Recent studies have shown that it is beneficial to screen those with thyroid disease for coeliac disease as well.
Juvenile Idiopathic Arthritis is another autoimmune disorder that shares common risk genes with coeliac disease. It is a type of arthritis that affects young people, resulting in joint inflammation, swelling and inability to move joints. Coeliac disease is around seven times more common in children with Juvenile Idiopathic Arthritis than in the general population.
Coeliac disease and type 1 diabetes also share a similar genetic profile; both are immune-mediated conditions. It is estimated that three to eight per cent of type 1 diabetics also have coeliac disease, however, in such patients it usually shows no symptoms (and is therefore ‘asymptomatic’), and thus is only found upon screening. If left untreated, coeliac disease may result in irregular blood glucose levels.
Around 15-25 per cent of people with coeliac disease experience dermatitis herpetiformis. This is a chronic condition resulting in very itchy, blistering skin rashes. It is considered to be the skin form of coeliac disease and commonly affects more men than women.
Despite the many conditions associated with coeliac disease, it does not mean that every person with coeliac disease will develop one of these conditions, however, one needs to be aware of such complications in order to take precautionary measures.
The author would like to thank Dr Rosemarie Sacco for kindly reviewing this article.