What is coeliac disease?
Coeliac disease is an autoimmune disease.
Coeliac disease is a condition in which you cannot tolerate gluten. Gluten is a collective term for proteins found in the grains wheat, rye and barley. Coeliac disease, sometimes also called gluten intolerance, is an autoimmune disease. This means the immune system attacks the body’s own healthy cells. In coeliac disease, the cells in the lining of the small intestine are damaged when you consume gluten. The lining becomes inflamed, and the intestinal villi are damaged and break down. This makes it increasingly difficult for the body to absorb important nutrients from food. This can lead to nutrient deficiencies and other, sometimes serious, problems and complications. Coeliac disease is effectively treated with a gluten-free diet.
Use the term coeliac disease
Coeliac disease has often been referred to as “gluten intolerance,” but the correct term is coeliac disease. The term “gluten intolerance” should be avoided, as it is now also used to describe other types of food sensitivity. That is why we use the correct term coeliac disease, which cannot be misunderstood.
The term “gluten allergy” is sometimes used, but that should also be avoided. Coeliac disease is not a classic allergy, but an autoimmune disease. There is, however, a wheat protein allergy (wheat allergy), which is a grain allergy that is entirely separate from coeliac disease.
APPROXIMATELY 2% OF SWEDES HAVE COELIAC DISEASE
Coeliac disease is a chronic condition, and getting a diagnosis is important
Coeliac disease is a chronic condition, which means it does not go away over time. This is because the immune system has a memory. Coeliac disease therefore cannot be cured today. However, the only “medicine” for coeliac disease is relatively uncomplicated and very effective: following a gluten-free diet. It is important that everyone with coeliac disease is diagnosed, because a gluten-free diet is a lifelong treatment and, without it, coeliac disease can lead to nutrient deficiencies. The diagnosis must be made within the healthcare system, and you cannot determine on your own whether you have coeliac disease. It is also important not to exclude gluten yourself before the investigation is complete, as this can make it impossible to confirm or rule out coeliac disease.
How is celiac disease treated?
By switching to a gluten-free diet after receiving a celiac disease diagnosis, the intestine gradually heals. This is a process that can take anywhere from a few weeks to 1–2 years, and in some cases many years. However, you often notice an improvement within a few weeks. At follow-up visits, how well the intestine is healing is assessed by the doctor reviewing your blood test results and asking questions about any remaining symptoms. Once the intestine has healed, the risk of secondary diseases or complications is small.
INCREASED AWARENESS
How common is celiac disease?
Celiac disease is now much more common than it used to be. Over the past decades, the disease has gone from being considered something unusual that only affected children to being a widespread public health problem in people of all ages. Awareness of the disease has also increased, both within healthcare and in society. At the same time, the tools for diagnosing celiac disease have steadily improved. Despite this, celiac disease is still unfortunately often missed.
Most screening studies suggest that celiac disease is present in about one percent of the population across the Western world, and one to three percent in Sweden. However, most people with celiac disease still remain undiagnosed. This is because far from everyone has—or feels they have—the classic gastrointestinal symptoms most often associated with celiac disease. Some instead have completely different symptoms, and some believe they have no symptoms at all.
Celiac disease has a hereditary (genetic) component
No one knows for sure when celiac disease begins. It seems to vary from person to person. It is believed that many people develop celiac disease as children, but the disease can also start later in life. There is a hereditary component because a certain type of genes (risk genes) is required in order to develop celiac disease. However, the vast majority of people with these risk genes never develop celiac disease. The risk of developing celiac disease is about 10–15% if you have a close relative (parent, sibling, or child) with celiac disease.
What triggers celiac disease?
No one is born with celiac disease; the disease develops only after the immune system has learned to react incorrectly to the protein gluten. Why it learns to react incorrectly is being researched worldwide. It is known that both certain gene types (celiac risk genes) and the presence of gluten in the diet are required. A third factor is the “trigger” needed to set the disease in motion. Only a small fraction of people with the genetic risk develop celiac disease. In Sweden, about half of the population has the genetic predisposition, but only about 2–6 percent of them develop celiac disease. This third factor—the trigger—is usually described as one or more environmental and lifestyle factors. Research is looking, among other things, at the influence of viruses, bacteria, infections (especially during the first years of life), the gut microbiome, and infant foods.