Coeliac disease

Understanding coeliac disease

What coeliac disease is

Coeliac disease is not an allergy and not an intolerance in the ordinary sense. It is an autoimmune condition in which gluten, a protein in wheat, barley and rye, triggers the immune system to attack the lining of the small intestine.

That lining is covered in finger-like projections called villi, which vastly increase the surface available for absorbing nutrients. In coeliac disease the villi flatten, and absorption falls. That is why the consequences reach far beyond the gut.

Understanding coeliac disease

Symptoms

The classic picture is diarrhoea, bloating, wind, abdominal pain and weight loss. Many patients, however, have few digestive symptoms at all and present instead with the effects of poor absorption.

• Iron-deficiency anaemia that does not respond well to iron
• Folate or vitamin B12 deficiency
• Persistent fatigue
• Mouth ulcers
• An itchy blistering rash, dermatitis herpetiformis
• Reduced bone density from poor calcium absorption
• Unexplained infertility or recurrent miscarriage
• In children, poor growth and delayed puberty

Understanding coeliac disease

Why it is missed in Nigeria

Coeliac disease was long considered a European condition. It is now recognised across Africa and the Middle East, and rising wheat consumption in Nigerian diets makes it more relevant than it once was.

The practical problem is that its symptoms overlap almost completely with IBS and with chronic infective diarrhoea, both of which are far more common here. Without specific testing, it is simply never considered.

Understanding coeliac disease

Getting tested properly

There is one rule that matters more than any other: do not start a gluten-free diet before you are tested.

Both the blood test and the biopsy depend on the immune reaction being active. Remove gluten first and both can be falsely normal, leaving you on a restrictive lifelong diet without ever knowing whether you needed it, and needing to eat gluten again for weeks to be tested properly.

Testing begins with coeliac serology, a blood test for specific antibodies. If positive, a gastroscopy with biopsies from the duodenum confirms the diagnosis by showing the characteristic flattening of the villi. Because the damage can be patchy, several samples are taken.

Understanding coeliac disease

Treatment

The treatment is a strict, lifelong gluten-free diet. There is no medication, and no version of the diet that permits occasional exceptions, because even small amounts reactivate the immune response.

In Nigeria this is more achievable than many people expect, since a great deal of traditional food is naturally gluten free: rice, yam, cassava, plantain, maize, beans, and dishes built around them. The difficulty lies with wheat-based bread, semolina, noodles, and with hidden gluten in sauces, seasoning cubes and processed foods.

Once gluten is removed, the lining heals over months, symptoms resolve and absorption recovers. Deficiencies are corrected in the meantime, and bone density is checked, since it is frequently affected at diagnosis.

Understanding coeliac disease

Family members

Coeliac disease runs in families. First-degree relatives, meaning parents, siblings and children, have a substantially higher risk than the general population and should be tested if they have any suggestive symptoms, and considered for testing even without them.