Coeliac Disease

What is Coeliac Disease?

Coeliac disease is an autoimmune disorder that happens when people who are genetically prone to it eat gluten. In these cases, the immune system attacks the small intestine, especially the villi, which are tiny finger-like structures that help the body absorb nutrients. When the villi are damaged, it becomes harder to absorb important nutrients like iron, calcium, and vitamins.

In fact, coeliac disease is not the same as a wheat allergy or non-coeliac gluten sensitivity. People with coeliac disease need to avoid gluten for life to protect their intestines and prevent other health problems.

What are the Types of Coeliac Disease?

Coeliac disease can present in different ways depending on the symptoms, extent of intestinal damage and how the condition is identified. The main types of coeliac disease include:

Stages of Coeliac Disease

Coeliac disease can impact different parts of the body, and symptoms often depend on how much the intestines are damaged and how each person reacts to gluten. Usually, the disease is described in two main phases:

How Common is Coeliac Disease in India?

Coeliac disease is relatively common in India, although its prevalence varies across different regions. A large study of 23,331 healthy adults found that the prevalence of coeliac disease was 8.53 per 1,000 people in northern India, compared with 4.66 per 1,000 in northeastern India and 0.11 per 1,000 in southern India.

The research shows that coeliac disease is more common in northern India and less common in the south. Still, the overall rate across India may differ, and local diets seem to have a strong influence.

What are the Symptoms of Coeliac Disease?

Common early and advanced symptoms of coeliac disease include the following:

What Causes Coeliac Disease?

The exact cause of coeliac disease is gluten consumption, but several other factors are also believed to increase the risk of developing the disease. These causes and risk factors include the following:

• Abnormal Immune Response: Coeliac disease occurs when the immune system reacts abnormally to gluten, a protein found in foods such as bread, pasta, cereals and biscuits.

• Gluten Exposure: Eating foods containing gluten can trigger or worsen the immune response in people who have coeliac disease.

• Family History: Having a close relative, such as a parent, brother or sister, with coeliac disease increases the risk of developing the condition.

• Genetic Factors: Coeliac disease is strongly associated with changes in HLA-DQ genes, which play an important role in the immune system and can be inherited within families.

• Damage to Intestinal Villi: Ongoing inflammation can flatten and damage the tiny, finger-like projections called villi, reducing the intestine’s ability to absorb nutrients effectively.

• Environmental Factors: Certain environmental factors may contribute to triggering coeliac disease in genetically susceptible people. Digestive infections, such as rotavirus infection during early childhood, are mentioned as a possible risk factor.

• Other Health Conditions: Certain health conditions can increase the risk of coeliac disease, including type 1 diabetes.

What are the Complications of Coeliac Disease?

Although coeliac disease can often be managed effectively with a strict gluten-free diet, untreated or poorly controlled coeliac disease may lead to complications such as:

• Iron-Deficiency Anaemia: Poor absorption of iron can cause persistent anaemia, resulting in tiredness, weakness, dizziness, and reduced exercise tolerance.

• Osteoporosis and Osteopenia: Reduced absorption of calcium and vitamin D can weaken the bones and increase the risk of low bone density and fractures.

• Infertility and Pregnancy Complications: Untreated coeliac disease may be associated with fertility problems and an increased risk of certain pregnancy complications.

• Neurological Problems: Some people may develop neurological symptoms such as headaches, numbness, tingling, balance problems, or difficulty concentrating.

• Dermatitis Herpetiformis: Coeliac disease can be associated with dermatitis herpetiformis, an intensely itchy blistering skin condition caused by an immune response to gluten.

• Growth and Development Problems: Children with untreated coeliac disease may experience poor growth, delayed puberty, weight loss, or nutritional deficiencies.

• Lactose Intolerance: Damage to the intestinal lining can temporarily reduce the ability to digest lactose, causing bloating, abdominal discomfort, and diarrhoea after consuming dairy products.

• Refractory Coeliac Disease: In rare cases, symptoms and intestinal damage may continue despite strict adherence to a gluten-free diet. This requires specialist assessment and treatment.

• Increased Risk of Certain Cancers: Long-standing, untreated coeliac disease is associated with an increased risk of certain intestinal cancers, although these cancers remain uncommon.

Related Diseases Comparison

Coeliac disease can share symptoms with other digestive conditions, but these conditions differ in their causes, affected areas and treatment.

Coeliac Disease vs Irritable Bowel Syndrome vs Crohn’s Disease

How is Coeliac Disease Diagnosed?

Doctors use different tests to confirm whether a person has coeliac disease and rule out other conditions. Such diagnostic methods include:

How is Coeliac Disease Managed?

Coeliac disease treatment focuses on relieving symptoms, reducing outbreaks, and preventing transmission. The available treatment options are as follows:

• Strict Gluten-Free Diet: The main treatment is lifelong avoidance of gluten, including foods containing wheat, barley, and rye. A dietitian can help create a nutritionally balanced gluten-free meal plan.

• Preventing Cross-Contamination: Separate utensils, cooking surfaces, storage containers, and food preparation practices may be necessary to prevent gluten-free foods from coming into contact with gluten-containing foods.

• Nutritional Supplements: If tests show you have any deficiencies, your doctor might suggest taking supplements like iron, folate, vitamin B12, calcium, or vitamin D.

• Dietitian Support: A qualified dietitian can help make sure your gluten-free diet gives you enough fibre, protein, vitamins, minerals, and calories.

• Treatment of Associated Conditions: If you have complications like anaemia, osteoporosis, dermatitis herpetiformis, or other nutritional deficiencies, you may need extra treatment.

• Regular Medical Follow-Up: Your doctor may recommend follow-up visits and blood tests to check how your symptoms are improving, your nutrition, and how well you are sticking to the gluten-free diet.

Medicines Used to Treat Coeliac Disease

The main medicines for coeliac disease include:

• Larazotide Acetate: Helps strengthen intestinal tight junctions and reduce the passage of gluten peptides through the intestinal lining.

• ZED1227: Inhibits tissue transglutaminase (TG2), an enzyme involved in making gluten peptides more likely to trigger an immune response.

• ALV003: A combination of enzymes designed to break down gluten peptides before they can trigger an immune response.

• Latiglutenase: An enzyme-based therapy being studied to break down immunogenic gluten peptides and potentially reduce intestinal damage after accidental gluten exposure.

• AN-PEP: An enzyme that breaks down gluten and is still under investigation as a potential treatment.

Coeliac Disease During Pregnancy

Coeliac disease can be managed during pregnancy with a strict gluten-free diet and appropriate medical supervision. Untreated coeliac disease may contribute to nutritional deficiencies, including iron, folate, vitamin B12, calcium, and vitamin D deficiencies, which can affect maternal health and pregnancy.

Pregnant women with coeliac disease should work with their doctor and, where appropriate, a dietitian to ensure adequate nutrition throughout pregnancy. Tips to manage coeliac disease during pregnancy include the following:

• Stick to a gluten-free diet for your entire pregnancy.

• Make sure to go to all your prenatal and medical checkups.

• Keep an eye on your iron, folate, vitamin B12, calcium, and vitamin D levels, following your doctor’s advice.

• Only take supplements that your healthcare provider suggests.

• Read food labels carefully to avoid accidental gluten exposure.

• Prevent cross-contamination when preparing meals.

• Consult a dietitian if you are finding it difficult to maintain a nutritionally balanced gluten-free diet.

• Report persistent diarrhoea, vomiting, weight loss, or other concerning symptoms to your doctor.

Can Coeliac Disease Be Cured?

Coeliac disease is a lifelong condition, but it can be managed by following a strict gluten-free diet. Once gluten is removed, symptoms usually begin to improve and the damaged lining of the small intestine can heal over time. Recovery may take several months, especially in adults or those with severe intestinal damage or nutritional deficiencies. Regular check-ups can help monitor recovery and ensure that nutritional needs are being met. Eating gluten can trigger symptoms and may continue to damage the intestine, increasing the risk of long-term complications.

Can Coeliac Disease Be Prevented?

There is currently no guaranteed way to prevent coeliac disease because genetic susceptibility plays an important role. However, early diagnosis and strict avoidance of gluten after diagnosis can prevent intestinal damage and reduce the risk of complications. Some of the measures to prevent it are as follows:

• Know Your Family History: People with a close relative who has coeliac disease should discuss their risk and possible testing with a healthcare professional.

• Seek Early Medical Advice: Evaluate persistent digestive symptoms, unexplained anaemia, or nutritional deficiencies rather than ignore them.

• Do Not Self-Diagnose: Do not try to diagnose yourself. Only start a gluten-free diet after proper testing or if your healthcare provider recommends it, since starting early can make diagnosis harder.

• Maintain Nutritional Balance: After you are diagnosed, make sure your gluten-free diet is balanced and gives you enough fibre, vitamins, minerals, and protein.

• Prevent Gluten Cross-Contamination: Careful food preparation and storage can help ensure that a gluten-free diet is maintained consistently.

Coeliac Disease Treatment Cost in India

The cost of coeliac disease treatment depends on the size, location, number of fissures, hospital charges, and the type of procedure performed. The following table includes the estimated treatment costs in India:

Does Health Insurance Cover Coeliac Disease?

Yes, health insurance may cover coeliac disease as an autoimmune condition, subject to the terms and conditions of the policy. A comprehensive health insurance plan may cover medically necessary consultations, diagnostic tests, hospitalisation, etc. Some critical illness insurance plans may provide a lump-sum benefit upon the first diagnosis of a covered critical illness, but the conditions covered and eligibility criteria vary between insurers and policies.

If coeliac disease existed before buying the policy, insurers may apply a waiting period for pre-existing conditions. For autoimmune diseases, this waiting period may commonly range from 2 to 4 years, depending on the policy. New health insurance policies may also have an initial waiting period of around 30 to 90 days. Therefore, it is important to check the policy wording carefully to understand the applicable conditions before purchasing a mediclaim policy.

How Much Health Insurance Coverage Is Needed for Coeliac Disease Treatment?

Coeliac disease generally requires long-term management rather than hospitalisation, but associated complications such as severe nutritional deficiencies, anaemia, osteoporosis, or other medical problems may increase healthcare expenses.

A health insurance policy that provides coverage ranging between ₹5 and ₹10 lakh is generally enough for regular treatments and most emergencies. If you want more financial security or have higher health risks, it may be better to choose a higher coverage amount for added peace of mind.

Living with Coeliac Disease in India: Daily Challenges & Care

Managing coeliac disease is not easy. It poses certain problems for the patient due to the strictness of the diet. Proper diagnosis and treatment, along with food selection, may help control the condition.