When you hear coeliac disease, do you imagine a thin, pale, sad child with a big belly, thin arms and legs, no appetite and voluminous stool? Did you learn that such children have to go on a gluten-free diet just for a couple of years and that it will disappear with puberty? It is not the case, or not exactly.

Common symptoms are: repeated or long-lasting diarrhea, fatigue, aching bones, abdominal pain, weakness, anaemia, muscle spasms. Children as well as adults can be diagnosed. The youngest patients are babies around the age of 6 months who present problems during the introduction of food containing gluten.

Celiac disease often appears shortly after the child is introduced to food containing gluten – semolina pudding, biscuits, soups thickened with flour, etc. Children start suffering from diarrhea, their stool is voluminous and malodorous. They have abdominal pains and their belly gradually grows. They start losing their appetite, are often weepy and grumpy. They lose weight and grow little. They can also suffer anaemia caused by the lack of iron.

With older children and adults, the disease often appears after a body burden (disease, pregnancy). Besides typical symptoms other symptoms can be present such as vomiting, diminished appetite, anaemia, osteoporosis, cariosity, aching joints, depression or fatigue. In extreme cases it can lead to a metabolism collapse or cancer.

A big change in diagnosing coeliac disease occured after the introduction of antibody testing. Some people, who were diagnosed e.g. within the frame of family check-ups and who present complex villous atrophy, can only have weak or partly unspecific symptoms. They suffer from abdominal pains, paradoxically even from constipation, delayed growth and puberty, decrease of calcium in bones (due to reduced absorbtion of calcium), anaemia, (reduced resorption of iron), joint inflammations, defects in tooth enamel.

The intensity of the reaction to gluten is individual. Some people have very weak reactions even if they eat a lot of food containing gluten; on the contrary others can have a violent and dispropertionate reaction to gluten

Since coeliac disease is an autoimmune disorder, it is associated with other diseases in which the immunity sysem attacks substances natural to the body. Some 5-10 % of coeliacs suffer from diabletes and vice-versa, roughly the same proportion of diabetics suffer from coeliac disease. The inflammation of thyroid associated with coeliac disease is as frequent as diabetes. Mainly adults can also have very itchy blistery rashes and only one in ten has gastrointestinal symptoms.

Treatment

Since coeliac disease is not an allergy but an intolerance, the patients can be almost 100% sure that they will be affected for life. The treatment is relatively easy – consistent gluten-free diet. Coeliacs must avoid not only bakery products but also pasta and all foodstuffs with added gluten – frankfurters, bonbons or even some kinds of yogurts. At the first sight, it is not always obvious that some products contain gluten as gluten is frequently used as an emulsifier since it carries aromatic substances.

As an alternative to ceraeals containing gluten, coeliacs can use millet, sweetcorn, rice, amaranth, buckwheat, soya beans, chestnuts. They can also eat vegetables including potatoes, lettuce, fruit, meat, fish, eggs, milk and dairy products. While on gluten-free diet, the organism or more precisely the small intestine mucosa slowly starts to heal.

Epidemiology

In the past, coeliace disease was rarely diagnosed, so the occurence was something between 1 out of 5000 to 1 out of 1000. Nowadays, in many European countries, the occurence is said to be as high as one in 250 and during a screening of certain populations, the number went even higher (e.g. 1 in 184 when screening 17000 Italian secodary school pupils). According to this research, celiac disease is one of the most frequent “chronic“ diseases.

The frequency of the occurence of the disease in different countries greatly varies. What is more, the date differs according to whether the disease is diagnosed on the basis of clinical symptoms or already on the basis of orientation tests. Taking into account only the symptomatic cases , the frequency is somewhere between 1:10 000 in Denmark and the USA and 1:3000 in Sweden and Great Britain. The worldwide average is approximately 1:3350. The risk of the disease is thought to increase if solid food is introduced too early into the baby’s diet. It is also more frequent with people with Down’s syndrom.

Precondition for the occurence of coeliac disease

Foreign literature states three necessary preconditions for the occurence of the disease in a patient:

  1. genetic predispositions of the patient
  2. gluten consumption
  3. a trigger which starts the disease

The trigger can be e.g. stress, trauma or a viral infection. It weakens the body which results in a demonstration of the disease in its acute phase.

 Accumulation of the disease in relatives of the first degree, especially in monovular twins can predict the dispositions. More than 95 % of all coeliacs possess a certain constellation of so called histocompatible antigens (HLA). However, 25 % of all people possess this HLA constellation and approximately 98 % tolerate gluten without any problems. We do not have the answer for the question why it is so. Research focuses on other genetic indications, but also on infections as possible concurrent factors.