Coeliac disease: symptoms and causes

By Cristiano Antonino On Dec 5, 2021

Coeliac disease is a chronic, autoimmune eating disorder that develops when people eat gluten and triggers an immune reaction in those genetically predisposed to it

Over time, this reaction produces inflammation that damages the walls of the small intestine and villi, thus preventing the absorption of food and nutrients.

Symptoms of coeliac disease

Symptoms of coeliac disease can vary greatly and do not always manifest themselves, especially in adults: among the most common are diarrhoea, abdominal bloating and meteorism, abdominal cramps, weight loss and asthenia.

One of the most frequent alterations in blood tests is anaemia, which is mainly caused by malabsorption of iron and vitamins due to atrophy of the intestinal villi; for the same reason, sufferers of coeliac disease often also have symptoms related to osteroporosis, because our bodies are unable to absorb the calcium necessary for healthy bones.

So when should we be alarmed?

The presence of abdominal symptoms, even non-specific ones, should always be correctly assessed by a specialist, especially if there are even minor alterations in the blood tests that cannot be explained by other causes.

Coeliac disease, the causes

The coeliac condition is a multifactorial disease: genetic, immunological, environmental.

Gluten is the triggering agent of the immune reaction in the genetically predisposed patient, but the environmental factors which precipitate the triggering of the autoimmune response can be multiple and some of them physiological, such as pregnancy or gastrointestinal infections.

Coeliac disease is also often associated with other autoimmune diseases including thyroiditis, type 1 diabetes mellitus, rheumatoid arthritis or thyroiditis and genetic syndromes (Down’s, Turner).

Coeliac disease, gluten intolerance and allergy: not to be confused

In addition to coeliac disease, gluten allergy is a type of manifestation of gluten-related disorders, along with ‘gluten sensitivity’.

The difference between the two types of manifestation is immunological and clinical: gluten allergy is mediated by antibodies of the IGE class (while the antibodies involved in coeliac disease are IgA and IgG), is not characterised by duodenal mucosal damage and can bring all the different symptoms typical of allergic reactions from skin reactions to respiratory difficulties to intestinal problems.

Treatment of coeliac disease

There is currently no drug therapy to treat coeliac disease.

The only treatment that can preserve the villi and intestines is diet: a scrupulous gluten-free diet must be followed.

This not only helps to manage and reduce symptoms, but also allows the intestine and mucous membrane to regain their original function.

But what are the risks of not following a gluten-free diet?

A coeliac patient who does not follow the diet keeps the inflammatory process in the duodenal mucosa constantly active, preventing the reconstruction of the absorbent surface of the intestine, and this puts him or her at risk, even if asymptomatic, of developing important nutritional deficiencies which in the long term will compromise the wellbeing of the organism. In addition, failure to adhere to the diet increases the risk of developing gastrointestinal neoplasms, particularly intestinal lymphoma.

Where does research stand?

Studies have been underway for years on various fronts, including research into a vaccine and the production of drugs capable of inactivating or masking the toxic fractions of gluten, which are responsible for triggering the inflammatory mechanism.

Progress has been made, but at present the only codified treatment for the disease remains the gluten-free diet.