Coeliac disease

A chronic autoimmune condition triggered by the ingestion of gluten in genetically predisposed individuals, causing inflammation and damage to the small intestinal mucosa.

• Prevalence in Europe is approximately 1%.
• Higher prevalence in first-degree relatives of affected individuals.

• Gastrointestinal symptoms: Diarrhoea, abdominal pain, bloating, weight loss, nausea, vomiting.
• Extraintestinal manifestations: Dermatitis herpetiformis, anaemia, osteoporosis, fatigue, mouth ulcers, infertility, neuropathy, ataxia.
• In children: Failure to thrive, delayed puberty, dental enamel defects.

• Serology: Anti-tissue transglutaminase (tTG) antibodies, anti-endomysial antibodies (EMA).
• Small bowel biopsy: Villous atrophy, crypt hyperplasia, increased intraepithelial lymphocytes.
• Duodenal biopsy is the gold standard for diagnosis.
• Genetic testing: HLA-DQ2 and HLA-DQ8.

• Gluten-free diet: Lifelong dietary restriction of gluten-containing foods.
• Referral to a dietitian for guidance and support.
• Calcium and vitamin D supplementation.
• Regular follow-up to assess dietary compliance and check for complications.

• Type 1 diabetes mellitus.
• Thyroid disorders.
• Autoimmune liver diseases.
• Down’s syndrome and Turner syndrome.

• Osteoporosis: Due to malabsorption of calcium and vitamin D.
• Small bowel lymphoma and adenocarcinoma (rare).
• Iron-deficiency anaemia.
• Infertility and recurrent miscarriage.

• Coeliac disease is a chronic autoimmune condition triggered by the ingestion of gluten in genetically predisposed individuals.
• Duodenal biopsy is the gold standard for diagnosis.
• Maintaining a gluten-free diet, is a key aspect in management, along with calcium and vitamin D supplementation and referral to a dietitian.
• Patient dietary compliance and regular follow-up is crucial to prevent and assess for complications.