coeliac disease is a systemic immune mediated multisystem disorder. It is triggered by dietary gluten in genetically susceptible individuals.Expression of the HLA DQ2 and HLA DQ 8molecules is an essential genetic component of the disease.
The onset of symptoms of coeliac disease is gradual and there may be a time lag of months to years after gluten exposure. Gluten is found in grains and starches such as wheat, rye, barley, couscous, bulgar and graham flour, as well as spelt.
The prevalence of coeliac disease is approaching 1% in most populations.
The frequency of the disease is increasing due to various factors such as the westernization of diets, changes in wheat production and increased awareness and diagnostic skills.
Who should be investigated for coeliac disease?
Patient with coeliac disease present with :
1.GASTROINTESTINAL SYMPTOMS such as diarrhoea-chronic or reccurent, abdominal pain and weight loss, distension .
2.EXTRAINTESTINAL CLINICAL CONDITIONS : Anaemia – unexplained, Dermatitis Herpetiformis, persistent apthous stomatitis, reproductive disorders and peripheral neuropathy .
3.ASYMPTOMATIC individuals with autoimmune disease eg diabetes mellitus type 1, autoimmune thyroiditis, Downs syndrome or first degree relative with proven coeliac disease
diagnosis : ask your doctor for the blood test it is IGA TTG antibody test and total IGA level, available at all laboratories and the patient must be consuming a diet with gluten at the time of doing the blood test.
Upper GI endoscopy and biopsy from the duodenum can confirm coeliac disease but if the TTG IGA is >10 x the upper limit of normal then the biopsy can be omitted.
The cornerstone of treatment is a gluten free diet for life.
