Coeliac Disease

 For my first physiology blog I decided to research Coeliac disease. My brother was diagnosed with coeliac in elementary school, so I have always been curious about the condition. Coeliac occurs when ingestion of gluten triggers a heightened autoimmune response. Recent studies suggest coeliac occurs in roughly 1% of individuals, which is higher than previously thought. Unfortunately, it can be difficult to diagnose. This is partially due to lack of reliable tests which diagnose the disease. Testing anti-reticulum bodies and anti-gliadin antibodies lack specificity for diagnosing the Coeliac. Other metrics revealed high false-positive results in patients with other mucosal damage in the gastrointestinal tract. The most accurate method for testing coeliac has been revealed to be Endomysial antibodies (EMA) and anti-tissue transglutaminase antibodies (tTG). Pairing these tests with a duodenal biopsy increases accuracy of diagnosis further. To show further prove the difficulty of diagnosis, the average delay of prognosis is an average of 13 years. Coeliac has a range of symptoms including steatorrhea, diarrhoea, weight loss and anemia. Other symptoms for less severe cases include iron deficiency, and osteoporosis. Despite this, it isn't even necessary to experience these symptoms to be diagnosed with the disease. If the biopsy reveals villous atrophy (damage to the small intestine) along with a positive result from the previously mentioned tests, a diagnosis is possible. The only treatment for Coeliac is a lifelong diet free of gluten. In most cases, negative side effects and long term consequences are removed after adherence to the diet. Doctors should follow up with patients annually to track diet compliance and make up for nutrient deficiencies. A concern of ethics with coeliac is the availability of faulty tests to the public. There are testing kits which draw a small amount of blood to measure tTG positivity, which isn't accurate enough to diagnose on it's own. However, this has led to patients self-diagnosing the disease, without a biopsy or any other diagnosable metrics. Coeliac requires multiple tests in order to confidently diagnose patients, and other autoimmune diseases might be at fault for results in that single test. This is a beneficence violation for patients who may need to go to the doctor to get a more advanced diagnosis for a disease which might not even be Coeliac. 

Citation: Burden S, Langley-Evans S, Talley N. Coeliac disease: pathogenesis, prognosis and management. J Hum Nutr Diet. 2014 Jun;27(3):203-4. doi: 10.1111/jhn.12233. PMID: 24826997.