Coeliac disease

Coeliac disease (also termed Sprue, Celiac disease [Am.] and Gluten Intolerance) is a disorder of the small intestine which impairs the body's ability to digest or absorb nutrients from food. The principal cause of the disorder is an immunologic reaction to components of dietary gluten. This is a cell-mediated reaction, not a typical IgE type allergy. The targets of the immunologic response are gliadins, proteins contained in the gluten component of wheat, barley, rye, and oats.

In most patients, a strict wheat and gluten-free diet will relieve the symptoms. Some patients suffer from refractory sprue. Many cases of refractory sprue are in patients exquisitely sensitive to even trace amount of gluten; thus, dietary restriction fails due to trace contamination of products with wheat proteins. In other patients, a sprue-like condition may be due to intolerance to other dietary proteins such as those found in egg, milk, or soy.

Table of contents

1 Signs and symptoms
2 Tests
3 Causes

Signs and symptoms

Loss of normal villous ("frilly") lining of the small bowel

Reduced surface area available for absorption

Coeliac disease improves dramatically when gluten (a protein found in wheat products) is removed from the diet
Causes diarrhea (with bulky pale offensive stools which may float) due to malabsorption in 50% of patients
Selective dietary deficiencies such as iron deficiency, B12 deficiency, osteoporosis (due to Vit. D malabsorption), or other secondary dietary deficiencies may be the sole symptom or found in addition to diarrhea
There is an increased risk of intestinal T-cell lymphoma in untreated cases
Runs in families

Tests

Characteristic appearance on bowel biopsy. Patients have gliadin antibodies.

Causes

Unknown but probably:

Partly a genetic susceptibility to the illness (identical twins do not have 100% concordence however).
together with an environmental agent, probably a virus or other infection
It is associated with other autoimmune disease (these diseases are also probably a combination of susceptibility + infection).