12 July 1998

Coeliac Disease More Prevalent Than Previously Thought

As reported in the June issue of the medical journal Current Therapeutics, the true prevalence of Coeliac Disease in people of European genetic origin may be higher than the previous clinical estimate of one in three hundred.

The disease is produced by mucosal damage to the small bowel as a consequence of dietary exposure to gluten in vulnerable individuals. The toxic fraction of gluten in coeliac disease is the alcohol-soluble protein component found in wheat, rye and barley. The disease results in malabsorption of nutrients from the bowel, causing illness through severe dietary deficiencies, and also predisposes to small bowel malignancy (with an 80-fold increase in risk of T cell lymphoma of the small intestine).

Vulnerability to gluten is probably conferred by a destructive T cell-mediated cellular immunological reaction, with genetic, viral, and/or other acquired causality.

Recent family and population studies indicate that milder forms of the disorder, presenting with diarrhoea, dyspepsia, or fatigue, are more common than had been previously recognised, and the emphasis in diagnosis is now on heightened awareness and earlier identification: using newly developed antibody testing for screening, with examination of duodenal tissue (via endoscope) as the ultimate and essential "gold standard" for the diagnosis.

Treatment, given that there is strict and life-long compliance with the recommended dietary restriction, is very successful, resulting in sustained clinical improvement after one or two weeks, and reduction in risk of malignancy to rates similar to those of the general population.

The recommended criterion for a food to be regarded as "gluten free" has become much more rigorous, and even trace amounts of gluten are no longer considered acceptable. Hence coeliac disease sufferers must forever totally avoid all foods containing wheat, rye, barley, and probably oats - which rules out much of the modern Western diet, including most convenience foods, and even most forms of beer!