Coeliac disease is a disease in which the body reacts negatively to gluten. Gluten is a type of protein found in wheat, rye and barley. When someone with coeliac disease eats foods containing gluten, it can cause damage to their small intestine. This can cause problems such as abdominal pain, diarrhea, fatigue and weight loss. The only effective treatment for coeliac disease is to avoid gluten-containing foods.
Diagnostics
The diagnosis of coeliac disease includes various forms, from potential to symptomatic. The prevalence of the disease is between 1:100 and 1:500, with children being affected more frequently than adults. Various tests can be carried out for the diagnosis of classic (gastrointestinal) manifestations.
Non-invasive diagnostics
This involves measuring antibodies in the blood, such as tissue transglutaminase IgA (tTG-IgA) or endomysium IgA (EmA), as well as total IgA. If IgA in the blood is low, additional tests such as IgG antibodies against tissue transglutaminase (tTG) or IgG antibodies against gliadin are carried out.
Invasive diagnostics
A gastroscopy (esophagogastroduodenoscopy) with biopsy of the duodenum is performed to investigate changes in the mucosa of the small intestine. A histological examination shows villous atrophy and increased T-cell values in the mucosa.
To confirm the diagnosis, certain criteria must be met, such as histological changes in the small intestine tissue and the presence of certain antibodies in the blood.
A medically controlled gluten challenge can be carried out if there is any doubt about the diagnosis. The patient is exposed to a defined amount of gluten while serological and histological tests are carried out.
The diagnosis of coeliac disease is certain if certain criteria are met, such as characteristic lesions in the small intestine tissue (Marsh-II to III), the presence of certain genetic markers (HLA-DQ2/8) and high antibody titres in the blood.
Therapy
The treatment of coeliac disease requires a strict gluten-free diet for life. This means avoiding all foods containing wheat, rye, barley and all products made from them. This can be challenging at first, which is why the support of a dietician is important. There are many gluten-free alternatives that can make the transition easier. Additionally, it is important to be aware of hidden gluten in processed foods, medications and other products. If symptoms persist despite adherence to a gluten-free diet, further medical evaluation should be done to rule out other possible causes or associated conditions.
Adherence to the gluten-free diet is crucial to heal the damage to the small intestinal mucosa and improve symptoms. If necessary, additional vitamin and mineral supplements can be prescribed to compensate for deficiencies caused by the disease.
Forecast
The prognosis for people with coeliac disease is generally very good, provided that the gluten-free diet is followed consistently. Adherence to this diet usually leads to a complete recovery of the small intestinal mucosa and a reduction in symptoms. In the long term, strict dietary adherence can reduce the risk of other health problems, such as osteoporosis, iron deficiency anemia, certain types of colon cancer and other autoimmune diseases. It is important to have regular follow-ups to monitor the healing process of the small intestine and to evaluate the effectiveness of the diet.
Continued education and awareness about the disease is also crucial to maintaining a good quality of life. Patients and their families are encouraged to connect with local and national celiac disease support groups for information, support and guidance.
