Definition and symptoms of coeliac disease
Coeliac disease is a disorder of the small bowel caused by an immune response to ingested wheat gliadins and related proteins in rye, oats and barley, resulting in inflammation and tissue damage. At least 1 in 70 people in Australia have coeliac disease. Asymptomatic and unrecognised disease is common; approximately 80% of people with coeliac disease are undiagnosedCoeliac Australia Limited.
The symptoms of coeliac disease are variable. The most common symptoms are fatigue, diarrhoea, weight loss, abdominal pain, bloating and indigestion; however, some people have no gastrointestinal symptoms. Other symptoms can also be associated with coeliac disease; people with the following symptoms or conditions should be screened for coeliac disease:
- a complication of malabsorption (eg iron-deficiency anaemia, osteoporosis)
- micronutrient deficiencies (eg unexplained iron, vitamin B12 or folate deficiency)
- an associated condition (eg dermatitis herpetiformis)
- primary infertility or recurrent miscarriages.
Screening for coeliac disease may also be required in:
- patients with some autoimmune diseases (eg thyroid disorders, immunoglobulin A [IgA] deficiency, type 1 diabetes)
- people with Down syndrome or Turner syndrome
- first-degree adult relatives of patients with coeliac disease as their risk of developing coeliac disease is about 1 in 10Bai, 2017. In first-degree relatives who are children, the need for screening should be discussed with the specialist.
All children and adolescents suspected of having coeliac disease should be referred to a paediatrician for assessment and management.
It is important to distinguish noncoeliac gluten sensitivity (ie gluten intolerance) from coeliac disease. In patients with noncoeliac gluten sensitivity, small amounts of wheat-based products are usually tolerated, and ingestion does not cause long-term damage. See Noncoeliac gluten sensitivity for more informationRubio-Tapia, 2013.