Coeliac Disease

Dr Calvin Ong

MBBS M.MED (SURGERY) MRCS FRCS

Coeliac disease is a chronic autoimmune disorder where the immune system reacts abnormally to gluten, a protein found in wheat, barley, and rye.

When people with coeliac disease consume gluten, their immune system attacks the lining of the small intestine, leading to inflammation and damage. This can interfere with the absorption of essential nutrients, which can cause a range of symptoms and health issues.

Causes and Risk Factors

The development of coeliac disease is influenced by a combination of genetic and environmental factors. These include:

Genetic Predisposition

Coeliac disease has a strong genetic component. Individuals who carry the HLA-DQ2 or HLA-DQ8 genes are more likely to develop the condition. Having close relatives (parents or siblings) with coeliac disease increases the risk.

Autoimmune Conditions

Individuals with other autoimmune disorders, such as type 1 diabetes or autoimmune thyroid disease, are at a higher risk of developing coeliac disease. The presence of one autoimmune condition may make the immune system more susceptible to developing others.

Environmental Triggers

Environmental factors, such as infections, changes in gut bacteria, or major life events such as surgery or stress, can trigger coeliac disease symptoms in genetically predisposed individuals.

Diagnosis of Coeliac Disease

Coeliac disease is diagnosed by assessing symptoms, ruling out other conditions, and using specific tests to confirm the diagnosis. These include:

Medical History and Symptom Assessment

The doctor assesses the patient’s symptoms, the duration, and whether symptoms worsen after consuming foods containing gluten. A family history of coeliac disease or autoimmune conditions may also be taken into account, as they increase the likelihood of the disorder.

Blood Tests

Blood tests are performed to detect specific antibodies that are elevated when gluten is consumed. It is necessary to continue eating gluten-containing foods before testing, as avoiding gluten may lead to false-negative results.

Endoscopy and Biopsy

If blood tests indicate coeliac disease, an endoscopy with biopsy is used to confirm the diagnosis. This procedure involves inserting a thin tube with a camera through the mouth and into the small intestine. Small tissue samples (biopsies) are taken from the lining of the small intestine to detect damage and inflammation.

Genetic Testing

Genetic testing can help rule out coeliac disease when blood test results are inconclusive. If the HLA-DQ2 or HLA-DQ8 genes are absent, coeliac disease is unlikely. However, having these markers does not guarantee the disease will develop.

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Treatment Options for Coeliac Disease

Treatment for coeliac disease aims to manage symptoms and prevent further damage to the small intestine. Treatment methods include:

Non-Surgical Treatment
Gluten-Free Diet

A gluten-free diet requires avoiding foods containing wheat, barley, and rye. This includes common foods like bread, pasta, and cereals, which may be substituted with gluten-free alternatives. Strict adherence to this diet helps the intestine heal, reduces symptoms, and lowers the risk of complications.

Nutritional Supplements

Malabsorption may cause deficiencies in iron, calcium, vitamin D, and B vitamins. Supplements can help correct deficiencies, especially during the early stages of treatment when the intestine is healing. A doctor may recommend supplements based on individual needs.

Medication

Medications may help manage specific symptoms or complications of coeliac disease. Dapsone or other anti-inflammatory drugs can control the rashes associated with dermatitis herpetiformis. In cases of severe intestinal inflammation or persistent symptoms, steroids or immunosuppressants may be prescribed to reduce immune activity and support healing.

Surgical Treatment
Small Bowel Resection

A small bowel resection involves removing a damaged portion of the small intestine. It may be necessary if complications arise, such as intestinal cancer, obstruction, or ulcers, or if severe intestinal damage occurs. The remaining parts of the intestine are reconnected to allow digestion to continue. This surgery is only considered when dietary changes and medications are not effective.

Managing Coeliac Disease

Managing coeliac disease focuses on maintaining a strict gluten-free diet and monitoring health regularly to prevent complications. Routine follow-ups ensure the condition is well-controlled and allow for adjustments in care if needed. Addressing nutritional deficiencies early supports recovery and helps maintain long-term well-being.

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Dr Calvin Ong Jianming

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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    Frequently Asked Questions

    Is coeliac disease the same as a gluten allergy?

    No, coeliac disease is an autoimmune disorder, not an allergy. In coeliac disease, consuming gluten triggers the immune system to attack the lining of the small intestine, leading to damage. A gluten allergy causes an immediate allergic reaction, differing from the delayed immune response of coeliac disease.

    Can cross-contamination affect people with coeliac disease?

    Yes, even small amounts of gluten from cross-contamination can trigger symptoms and cause intestinal damage. This can occur if gluten-free foods come into contact with gluten-containing foods during preparation, cooking, or storage. Using separate utensils, cutting boards, and cookware helps prevent contamination.

    How is coeliac disease managed in children?

    Managing coeliac disease in children requires strict adherence to a gluten-free diet, similar to adults. Collaboration with a dietitian ensures the child’s diet is balanced and meets nutritional needs. Regular follow-ups with a paediatrician can help monitor growth, development, and overall health.

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