Question 1

What is coeliac disease?

Accepted Answer

Coeliac disease is an immune-mediated systemic disorder triggered by ingestion of gluten — a protein complex found in wheat, barley and rye — in genetically susceptible individuals (HLA-DQ2 or HLA-DQ8 positive). The immune response to gluten (particularly gliadin peptides) causes inflammation and progressive flattening of the small intestinal villi (villous atrophy), impairing nutrient absorption. It affects approximately 1% of the global population but approximately 80% remain undiagnosed.

Question 2

What are the symptoms?

Accepted Answer

Coeliac disease has a highly variable presentation: Classical (GI) symptoms: diarrhoea, steatorrhoea (fatty stools), bloating, abdominal pain, weight loss. Non-classical presentations (increasingly recognised as the most common): iron-deficiency anaemia (from duodenal malabsorption); osteoporosis/osteopenia; infertility and recurrent miscarriage; peripheral neuropathy; ataxia (gluten ataxia); mouth ulcers; dermatitis herpetiformis (intensely itchy blistering skin rash — the skin manifestation of coeliac disease); and fatigue. Asymptomatic coeliac disease (discovered on screening of at-risk groups) is common.

Question 3

How is coeliac disease diagnosed?

Accepted Answer

On a gluten-containing diet (essential for accurate testing): serological testing with anti-tTG IgA antibody (high sensitivity/specificity); if positive, duodenal biopsy (at least 4-6 biopsies from the duodenum) to confirm villous atrophy (Marsh 3). HLA-DQ2/DQ8 testing can exclude coeliac disease (if negative, CD is virtually excluded — useful in equivocal cases). Important: testing must be done while the patient is eating gluten — a gluten-free diet normalises serology and allows mucosal healing, making diagnosis impossible.

Question 4

What is the treatment for coeliac disease?

Accepted Answer

The only currently effective treatment is a strict, permanent gluten-free diet (GFD) — eliminating all wheat, barley and rye. Oats are controversial (most guidelines recommend avoiding due to contamination risk; pure oats may be tolerated by many). A trained coeliac specialist dietitian is essential for dietary education. On a strict GFD: serological markers normalise within 6-12 months; mucosal healing occurs in approximately 97% within 2 years (slower in older adults). Nutritional deficiencies (iron, folate, calcium, vitamins D, B12, zinc) should be supplemented during the healing phase.

Question 5

Is coeliac disease the same as gluten intolerance or wheat allergy?

Accepted Answer

These are three distinct conditions: Coeliac disease: autoimmune; causes villous atrophy; IgA anti-tTG positive; HLA-DQ2/DQ8; lymphoma risk; strict GFD essential. Non-coeliac gluten sensitivity (NCGS): symptoms improve with GFD but no villous atrophy or positive serology; mechanism unknown; no lymphoma risk; some patients may tolerate small amounts. Wheat allergy: IgE-mediated immune response to wheat proteins; typically rapid-onset symptoms; diagnosed by skin prick test or specific IgE; may be outgrown; may allow other cereals.

Question 6

What complications does untreated coeliac disease cause?

Accepted Answer

Malabsorption complications: iron-deficiency anaemia (most common); osteoporosis/osteopenia (calcium and vitamin D malabsorption); nutritional deficiencies (folate, B12, fat-soluble vitamins); growth failure in children. Reproductive: infertility, recurrent miscarriage, low birthweight. Neurological: peripheral neuropathy, gluten ataxia, epilepsy. Malignancy: enteropathy-associated T-cell lymphoma (EATL — rare but serious); small bowel adenocarcinoma (rare). Autoimmune: co-occurring type 1 diabetes (10-fold increased risk), thyroid disease, primary biliary cholangitis.

Question 7

Are drug treatments for coeliac disease in development?

Accepted Answer

Multiple pharmacological approaches are in clinical trials: Gluten-degrading enzymes (latiglutenase — cleaves gluten in the stomach before it reaches the intestine); TG2 inhibitors (blocking the enzymatic modification that makes gluten more immunogenic); anti-IL-15 antibodies (reducing the IEL expansion central to EATL risk); AMG 714 and other anti-IL-15 approaches for refractory coeliac disease. No drug has yet been approved — the strict gluten-free diet remains the only treatment.

Question 8

How does GMJ News cover coeliac disease?

Accepted Answer

GMJ News covers WHO and BSG coeliac disease data, diagnostic delay, anti-tTG testing, GFD management, EATL risk and drug pipeline. Coeliac disease is underrecognised in Georgia — iron-deficiency anaemia workup should include coeliac serology — directly relevant to PHIG's gastrointestinal health priorities.

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