Coeliac disease is a chronic digestive disorder caused by intolerance to gluten, a protein found in wheat and wheat products. Coeliac disease leads to damage of the small intestinal lining. This can result in impairment in absorption of fats and other nutrients into the bloodstream.
There are no accurate estimates of the incidence of coeliac disease in the South African population. The disease tends to affect individuals of European descent. Estimated incidence in the UK is 1:100. The incidence in South Africa is thought to be much lower, especially in the indigenous population.
The disease is more common in women, with a female: male ratio of 2:1. It affects all age groups, including infants and children.
The severity varies widely between individuals. It has been found that some people who have the small intestinal abnormalities characteristic of the disease do not suffer any symptoms at all.
There appears to be a hereditary component to the disease, since the incidence among siblings is much higher than in the general population.
Siblings can have a prevalence of 10% of coeliac disease, much higher than the general population. However, the cause of coeliac disease is complex and multifactorial. It is not regarded as purely an inherited disease.
People with coeliac disease have a higher frequency of what are called serum histocompatibility antigens – HLA antigens. The HLA system is part of the immune system, and is a series of four gene families, which provide the coding for a particular protein present on the surface of cells.
When two individuals have identical HLA types, they are said to be histocompatible. HLA-DQ2 has been found in 90% of people with coeliac disease, as compared with 20 to 25% in the normal population. This indicates the nature of the hereditary component of the disease.
Reviewed by Dr Ismail Moola MBCHB (UCT) FCP (SA) Cert Gastro Phys (SA), February 2015.
Specialist Physician / Gastroenterologist Netcare Sunninghill Hospital and part time Lecturer Department of Internal Medicine, Division of Gastroenterology, Wits University.
Previously reviewed by Dr G Watermeyer MBChBFCP (SA), Cert Gastroenterology (SA), Consultant GIT Clinic Groote Schuur Hospital.