Gluten sensitivity, medically known as coeliac disease, is an autoimmune condition affecting an increasing number of people, which can cause serious digestive and other symptoms. Many people live for years without a diagnosis, suffering from unpleasant symptoms, whilst the solution lies in following a special diet. This article provides a detailed overview of the background to gluten sensitivity, its symptoms, the diagnostic process, the basics of a gluten-free diet, and the latest treatment options, with particular regard to Endomedix Gastroenterology Centre to procedures also used by [...].
Coeliac disease is an autoimmune disorder triggered by the consumption of gluten in individuals who are genetically predisposed to it. In response to gluten – a protein found in wheat, rye and barley – the body’s immune system mistakenly attacks the tissues of the small intestine. This process leads to the atrophy of the villi, which are essential for the proper absorption of nutrients. As a result, nutrient deficiencies and a number of related health problems may develop. It is important to note that coeliac disease is not a gluten allergy, but a complex autoimmune process that can develop at any stage of life.
Typical symptoms of gluten sensitivity
The symptoms of coeliac disease can vary greatly, which often makes it difficult to diagnose. Symptoms can differ between children and adults, and their severity also varies from person to person. Some people experience distinct gastrointestinal symptoms, whilst in others only mild, non-specific symptoms indicate the condition.
Classic gastrointestinal symptoms
These symptoms directly affect the digestive system, and are most often what prompt patients to see a doctor:
- Recurrent, chronic diarrhoea: Typically in the form of light-coloured, bulky stools with a greasy sheen and an unpleasant odour.
- Bloating and abdominal pain: An unpleasant, bloated feeling caused by the build-up of intestinal gas.
- Nausea and vomiting: It is particularly common in childhood.
- Constipation: Although less common, it is possible to experience constipation instead of, or in alternation with, diarrhoea.
- Loss of appetite and weight loss: Due to malabsorption of nutrients and unpleasant symptoms.
Symptoms outside the digestive system
Inadequate absorption of nutrients affects the whole body, which is why a number of symptoms that do not appear to be related to digestion may also occur:
- Iron-deficiency anaemia: One of the most common non-gastrointestinal symptoms in adults, which is accompanied by paleness, tiredness and weakness.
- Fatigue and lethargy: Due to general nutrient deficiencies and inflammatory processes taking place in the body.
- Osteoporosis: Due to impaired absorption of calcium and vitamin D.
- Skin problems: Dermatitis herpetiformis Duhring is a specific, intensely itchy, blistering skin condition that is closely linked to coeliac disease.
- Neurological problems: Headaches, migraines, balance disorders (ataxia) and peripheral neuropathy (numbness in the limbs) may also occur.
- Reproductive disorders: In women, this may lead to infertility and miscarriages, whilst in men it may result in a reduced sex drive.
- Delayed puberty and growth disorders: It may be a warning sign in childhood and adolescence.
Diagnosis of coeliac disease
If gluten sensitivity is suspected, a thorough gastroenterological investigation is essential. The diagnosis involves several stages, and it is extremely important that the patient does not switch to a gluten-free diet of their own accord during the tests, as this can skew the results, leading to a false-negative finding. The Endomedix Gastroenterology Centre Its specialist doctors use modern diagnostic techniques to help establish an accurate diagnosis.
Serological (blood) tests
The first step is usually a blood test to measure the levels of specific autoantibodies associated with coeliac disease. These antibodies are produced by the body’s immune response to gluten.
- Antibodies against tissue transglutaminase (tTG): This is the most sensitive and specific test for screening for coeliac disease.
- Anti-endomysium antibodies (EMA): This is also a highly accurate test.
- Antibodies against deaminated gliadin peptide (DGP): It is particularly useful for young children and people with tTG deficiency.
Genetic testing
Coeliac disease almost exclusively develops in people who carry the HLA-DQ2 or HLA-DQ8 genes. The absence of these genes rules out the possibility of coeliac disease with almost complete certainty. Genetic testing can therefore be useful in uncertain cases or when screening family members. The presence of these genes does not in itself indicate the disease, but merely a predisposition to it.
Small bowel biopsy
The gold standard for diagnosing coeliac disease is the histological examination of a tissue sample (biopsy) taken from the small intestine. This is carried out during a gastroscopy. During the procedure, small tissue samples are taken from the initial section of the small intestine, the duodenum, using a flexible instrument. The histological examination reveals the characteristic atrophy of the intestinal villi (villous atrophy), which confirms the diagnosis.
The gluten-free diet: the only effective treatment
The only currently known effective treatment for coeliac disease is a strict, lifelong gluten-free diet. The aim of the diet is to completely eliminate gluten from the diet, which allows the villi of the small intestine to regenerate and the symptoms to subside.
Prohibited foods
When following a gluten-free diet, you should avoid all foods containing wheat, rye, barley or their derivatives.
- Cereals: wheat (including spelt and durum wheat), rye, barley.
- Processed products: traditional breads, baked goods, pasta, semolina, breadcrumbs, biscuits, muesli.
- Hidden sources of gluten: Many processed foods may contain hidden gluten. These can include soup powders, sauces, tinned meat, cold cuts, flavoured dairy products, beer, whisky and certain grain spirits. You should always check the product label carefully!
Edible foods
Fortunately, there is now a wide range of gluten-free alternatives available, and many ingredients are naturally gluten-free.
- Gluten-free grains: rice, maize, millet, buckwheat, quinoa, amaranth.
- Vegetables and fruit: All fresh or frozen fruit and vegetables can be eaten.
- Meat and fish: Natural, unprocessed meat and fish are gluten-free.
- Dairy products: Plain milk, quark, yoghurt and cheese are generally gluten-free, but you should check the labels on flavoured varieties.
- They are thin: beans, lentils, chickpeas.
- Potatoes, sweet potatoes.
Sticking to the diet can be challenging at first, but with the help of a dietitian and careful planning, it is possible to develop a balanced and varied diet.
Modern therapeutic options and research
Although a gluten-free diet is extremely effective, the constant vigilance it requires can be a burden for patients. Accidental gluten consumption (cross-contamination) can cause unpleasant symptoms. Researchers are therefore working intensively on alternative therapies that could complement or even replace the diet in the future.
Treatment of refractory coeliac disease
In a small percentage of patients, symptoms and the histological picture do not improve despite a strict gluten-free diet. This condition is known as refractory coeliac disease (RCD). There are two recognised types:
- Type I RCD: In such cases, immunosuppressant drugs (e.g. steroids, azathioprine) are used to reduce inflammation of the bowel.
- Type II RCD: This is a more serious condition in which an abnormal lymphocyte population develops in the intestine, increasing the risk of enteropathy-associated T-cell lymphoma (EATL), a rare form of intestinal cancer. Treatment is complex and may involve cytostatic drugs, biological therapy (e.g. alemtuzumab) and even autologous bone marrow transplantation.
The diagnosis and treatment of refractory coeliac disease should only be carried out at centres with a high level of specialist expertise, such as the Endomedix Gastroenterology Centre It could happen.
Therapies currently in the trial phase
A number of promising research projects are currently underway into the pharmacological treatment of coeliac disease:
- Enzyme therapies: They are developing enzymes capable of breaking down gluten in the stomach before it reaches the small intestine and triggers an immune response.
- Medicines that reduce intestinal permeability: These substances target the permeability of the intestinal wall, preventing gluten from passing through it and triggering the immune system.
- Immunosuppressive and immunotherapeutic procedures: Work is currently underway to develop medicines that specifically inhibit the immune response triggered by gluten. This includes the concept of a „gluten vaccine”, which aims to induce tolerance to gluten in the immune system.
These treatments are still at the experimental stage, but they offer hope that the quality of life for patients with gluten sensitivity may improve further in the future.
Life after the diagnosis
A diagnosis of coeliac disease requires a significant change in lifestyle, but it also offers the opportunity to lead a symptom-free, healthy life. By strictly adhering to a gluten-free diet, the villi in the gut regenerate, symptoms disappear, and the risk of long-term complications (e.g. osteoporosis, cancer) is significantly reduced.
Regular follow-up appointments with a gastroenterologist are important, as the specialist monitors the patient’s progress, checks that the diet is being followed, and identifies any complications at an early stage. The Endomedix Gastroenterology Centre Their experienced specialists provide support to their patients not only with diagnosis but also with the long-term management of coeliac disease.
If you experience any of the symptoms described above, do not delay getting checked! Early diagnosis and starting the appropriate treatment are key to regaining a full quality of life.
