Coeliac disease

What it is

Coeliac disease is an enteropathy in which the gliadin fraction of gluten provokes a damaging immunological response in the proximal small intestinal mucosa. It occurs secondary to the ingestion of wheat gluten or related rye and barley proteins in genetically predisposed persons. Gluten is broken down to gliadin, which is the toxic factor, and the result is an abnormal small intestine mucosa due to the intestinal reaction to gluten. HLA-DQ2 (chromosome 6) is found in 80-90% of patients. It is associated with other autoimmune disease, especially Sjogren's, thyroid disease and type 1 diabetes mellitus. Type 1 diabetes mellitus and autoimmune thyroid disease occur more commonly in patients with coeliac disease, and any autoimmune work up should cover type 1 diabetes, thyroid disease and coeliac disease. It goes by several names: celiac sprue, non-tropical sprue, gluten-induced enteropathy and gluten-sensitive enteropathy. It is 3x more common in women, and it may develop at any age; peak incidence is the 5th decade in adults and 4 yrs in children. The groups at increased risk, with the percentage of each group affected, are first-degree relatives of a person with celiac disease at 10, second-degree relatives of a person with celiac disease at 3 to 6, and then, among persons with the following conditions, Down syndrome at 8, Williams syndrome at 8, Turner syndrome at 6, autoimmune thyroid disorders at 3, immunoglobulin A deficiency at 2 to 8, and type 1 diabetes mellitus at 2 to 5 in adults and 3 to 8 in children, against 1 in the general population.