Featured Article Summary #102

Coeliac disease is a long-term autoimmune condition that mainly affects the small intestine. It happens when the immune system reacts inappropriately to gluten, which is found in wheat and other grains like barley and rye. The symptoms can vary widely and may affect other parts of the body as well, sometimes causing malabsorption problems such as weight loss, diarrhoea, and poor growth in children, or vague abdominal symptoms and complications like anaemia and bone problems in adults. Diagnosis usually involves a review of symptoms, blood tests, and a small-bowel biopsy, and testing may require gluten to be eaten beforehand. The main and only treatment is a lifelong gluten-free diet, which can lead to symptom improvement within days and help prevent further complications. Coeliac disease affects about 1 in 200 to 1 in 50 people, is more common in children under 10, happens slightly more often in women, and is still believed to be underdiagnosed despite rising awareness and better blood testing. “Coeliac disease” is the preferred name in Commonwealth English, while “celiac disease” is more common in North America. Other older terms have been used as synonyms, but some like “gluten intolerance” and “gluten sensitivity” are not specific, and related “gluten-related disorders” can include several conditions such as gluten ataxia and wheat allergy. People with coeliac disease may have no symptoms (often found through screening), or may have symptoms that can be classical (malnutrition, malabsorption, diarrhoea) or non-classical (mainly not related to malabsorption). Possible forms include “potential coeliac disease” (positive blood tests but no intestinal damage), and “silent” or “latent” terms are discouraged because their meanings are inconsistent. If symptoms continue on a gluten-free diet, it may be “slow/non-responsive coeliac disease” (after 6–12 months) or “refractory coeliac disease” (after at least 12 months), with refractory disease split into type 1 and type 2 based on how the intestine looks under a microscope. Coeliac disease can cause many different symptoms and complications affecting several organs. It may appear as classic coeliac disease (often in children) with gut problems such as diarrhoea, weight loss and poor growth, or as non-classic disease (more common in adults) where symptoms are mainly outside the intestine. Some people who think they have no symptoms are actually unwell over time, and once they start a gluten-free diet and feel better, they may look back and recognise earlier problems they had not noticed. In coeliac disease, diarrhoea is usually long-lasting, can be pale, large in volume, and often has a strong unpleasant smell. People may also have abdominal pain, cramps, bloating, and mouth ulcers, and as the intestines become more damaged they may develop lactose intolerance. Coeliac disease is a whole-body condition, so besides gut symptoms it can cause extraintestinal problems linked to malabsorption and inflammation. These may include headaches, fatigue, brain fog, muscle and joint pain, plus nutritional deficiencies such as iron, folate, zinc, vitamin D and vitamin B12, which can lead to anaemia, weak bones (osteopenia/osteoporosis), hormone and reproductive issues, and kidney stones. It can also affect the liver, causing “coeliac hepatitis,” where liver enzyme levels rise mildly without other causes. Rare presentations may include nerve problems, epilepsy, psoriasis, mouth ulcers, fluid around the heart, and Lane-Hamilton syndrome.