What is Coeliac Disease?

Coeliac disease is a disorder characterized by damage to the lining of the small intestine. The damage is caused by a hypersensitive reaction to gluten - the protein found in wheat and rye. Gluten is also closely related to avenin, a protein found in oats, and hordein, a protein found in barley. In practice, we refer to all of these proteins collectively, if rather inaccurately, as 'gluten' The immune system reacts against components of gluten, and destroys the lining - the absorptive surface - of the small intestine. As a result, the absorptive capacity of the intestine is greatly reduced and important dietary components are not absorbed into the body. This absorption, as we call it, affects proteins, carbohydrates and fats, as well as some essential vitamins and minerals. This leads on directly to nutritional deficiencies and abnormal stools.

Nutritional deficiencies in coeliac disease
The essential nutrients which a coeliac may not absorb include vitamin B12, folic acid and (less commonly) iron. These deficiencies result in anemia (a low blood count). Other nutrients at risk include the B vitamins, vitamin K and potassium. Such deficiencies result, respectively, in tongue and mouth changes, bruising and weakness. Finally, vitamin D and calcium absorption may result in soft, tender bones and muscle weakness.

Stool changes in coeliac disease
Think about this for a moment. If what we eat is not absorbed it passes unchanged through the small intestine into the large, eventually appearing in the stool. In coeliac disease, it is the undigested fats, in particular, which alter the nature of the stool. They impart a greasy, bulky and frothy appearance. The fatty stool is also lighter than normal, and this explains why it floats on the water, and why it is so difficult to flush away. Furthermore, this very abnormal stool alters both the nature and the activity of resident bacterial colonies, allowing bacterial overgrowth to occur. This results in excessive gas production and foul-smelling stools.

The symptoms of coeliac disease are easily understood from the foregoing, and include:
1. pale smelly stools, which are bulky, greasy and frothy
2. bloated abdomen
3. diarrhea or, less commonly, constipation
4. smelly flatulence
5. abdominal colic
6. vomiting
7. poor appetite
8. weight loss
9. lethargy and misery

Coeliac disease may appear for the first time in either childhood or adulthood. The vast majority of affected children are diagnosed before they are two years old, and the remainders are picked up by their fifth birthday. The disease may also present in later life, particularly during the third to sixth decades. As one might expect, coeliac disease occurs only in those parts of the world where gluten is ingested, and particularly amongst populations of European origin. The highest documented incidence of coeliac disease is in the west of Ireland.

Source: Gut Instincts by Andrew Brett and Andrea Carson