Coeliac disease
Coeliac disease - also known as gluten sensitive enteropathy ("entero-" refers to the gut, and "-pathy" means abnormal, so this is a gut abnormality caused by a sensitivity to gluten) causes atrophy, or shrinkage, of the villi and also the absorptive crypts. There may be failure of absorption of fats, proteins, vitamins and minerals, causing diarrhoea, malaise and weight loss (although many cases are asymptomatic). In the child it presents as failure to thrive in a toddler with diarrhoea. The sensitivity is to a protein called gliadin contained in wheat, barley and rye. The condition is genetically determined, and is much more common in the West of Ireland than in other regions. Strictly the diagnosis depends on the appearance of the mucosa of the small intestine obtained by biopsy using endoscopy - a process using a fibre optic tube placed in the stomach. Following a gluten-free diet for a period of time should allow the symptoms to resolve, and the mucosal lining of the intestine to be restored to normal. In some patients a blood test shows a positive result for antigliadin antibodies.
Besides diarrhoea and symptoms related to malabsorption, such as anaemia or osteomalacia (a failure to deposit calcium in bone due to vitamin D deficiency) there may be an itchy blistering skin rash called dermatitis herpetiformis. This also should resolve over a period of time on a gluten free diet, but it may require other treatment.
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