Coeliac disease can become apparent at any age, although most cases are diagnosed in early childhood or in middle age. Coeliac disease may remain clinically silent and people with circulating antibodies to tTG, but no overt pathology, may be considered to have latent disease.
Malabsorption causes diarrhoea and weight loss. Inability to absorb fats results in steatorrhoea, with bulky, pale, foul-smelling stools that float in water, because of their high fat content. Anaemia, caused by iron deficiency is frequent. Malabsorption of calcium and vitamin D increases the risk of developing osteoporosis.
Nutrients that are mainly absorbed in the proximal small intestine, such as iron and calcium, are most affected by coeliac disease, while nutrients predominantly absorbed in thejejunum and ileum, such as folic acid, vitamin C and vitamin B12, are affected only in more advanced disease.
Patients may complain of abdominal pain and tiredness and, for unknown reasons, neurological complaints, ranging from mild peripheral neuropathy to more severe central nervous system disturbance, occur in up to 10% of patients.
A small number of people develop a blistering rash called dermatitis herpetiformis, associated with antibodies to tTG reacting with a form of this enzyme in dermal cells.
Possibly as the result of chronic inflammation, people with uncontrolled coeliac disease are at increased risk of developing intestinal neoplasms, particularly intestinal lymphoma. This risk is substantially reduced by strict adherence to a gliadin-free diet (see Chapter 38).
All these signs and symptoms disappear when gliadin is omitted from the diet and reappear if it is reintroduced.
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What Is The Gluten Free Diet And What You Need To Know Before You Try It. You may have heard the term gluten free, and you may even have a general idea as to what it means to eat a gluten free diet. Most people believe this type of diet is a curse for those who simply cannot tolerate the protein known as gluten, as they will never be able to eat any food that contains wheat, rye, barley, malts, or triticale.