Coeliac Disease affects 1 in 100 people in the UK, however, according to Coeliac UK (www.coeliac.org,uk) only 24% of those with the condition have been medically diagnosed meaning nearly half a million people may have the condition but not yet know it. Getting a proper diagnosis with any condition, is vital to ensure the correct advice and treatment is given. The problem for people affected by Coeliac Disease is that the symptoms can often be wide ranging making diagnosis more difficult.
Coeliac Disease is an autoimmune condition where the body reacts in an adverse way to the presence of an element of gluten, known as gliadin, in the diet. Gluten is a protein found in cereals such as wheat, barley and rye. This adverse reaction causes damage to the lining of the small intestine.
It’s not known exactly what causes Coeliac Disease, or why some people have more severe symptoms than others. Risk appears to increase within families with a risk of about 10% for those with a relative who has Coeliac Disease. Developing an infection such as rotavirus in early life may also play a role in the development of the condition, but this is not the only factor involved. Early weaning with gluten containing food, before 3 months of life, is also thought to be a risk factor. Current advice states that gluten should not be introduced to a baby’s diet until at least 6 months of age.
Other conditions such as ulcerative colitis, type 1 diabetes and neurological conditions such as epilepsy also appear to be linked to Coeliac Disease but it is not yet known whether these are independent risk factors for developing Coeliac Disease, or whether they maybe just have the same underlying cause, which is as yet unknown.
**What happens inside to someone with untreated Coeliac Disease?**
In a healthy person the gastrointestinal tract, sometimes referred to as the gut, consists of different sections. One of the most biologically active areas is the small intestine. Here, there are finger like projections all over the surface of the intestines called villi. These villi, and microscopic hairs covering the surface of the villi (known as micro-villi) increase the surface area of the small intestine which results in a very efficient surface for the absorption of nutrients from the intestine into the bloodstream.
In fact, the simple small intestine tube has a surface area of about 2 square feet in area, but if the total surface area including the villi and micro-villi was included this would increase to cover an entire tennis court in size!
Not only do the villi increase the surface area required for absorption – they also tend to store and hold the important enzymes we need to break down foods into the right size nutrients to be absorbed.
When an individual has Coeliac Disease, gluten causes an immune reaction – firstly the white blood cells in the villi increase in number and this eventually causes an inflammation in the villi. As this inflammation continues, damage occurs which leads to a flattening of the villi reducing the surface area of the small intestine dramatically. In some cases, the villi can be completely lost from the small intestine.
**What effect does this have?**
Severe inflammation of the small intestine resulting in damage to the villi can have severe effects on an individual. If you can imagine the surface area of the small intestine reducing in size, but at the same time being inflamed and damaged this can partly explain some of the symptoms that individuals with Coeliac Disease experience including abdominal pain, difficulty digesting and absorbing food resulting in vomiting and/or diarrhoea, nutrient deficiencies and poor growth patterns in children.
**Is there a treatment?**
The human body is amazing, and despite the severe damage caused to the small intestine in individuals with Coeliac Disease, the villi and microvilli are able to recover. In most cases avoiding the root cause of the inflammation, allows the regeneration of the small intestine, and in many cases a complete recovery. The only possible way to do this is through the complete avoidance of gluten – the cause of the problem. Following a lifelong gluten-free diet allows individuals with Coeliac Disease to manage their condition, however even a trace amount of ingested gluten can lead to a flare up of unpleasant symptoms.