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Coeliac disease is clinically very variable and so is defined pathologically as a permanent gluten-sensitive enteropathy. The mucosal lesions seen on upper GI biopsy are the result of an abnormal, genetically determined, cell-mediated immune response to gliadin, a constituent of the gluten found in wheat. A similar response occurs to comparable proteins found in rye and barley. Gluten is not found in oats, rice and maize.
Coeliac disease was first identifed by Samuel Gee in 1888. However, it was
W. Dicke in the 1950s who identified the dietary link, noting that patients
with this condition were apparently cured by the deprivations of World War II,
but relapsed when rationing was abolished.
Note the threshold amount of gluten in 'gluten-free' products that can be tolerated
by people with coeliac disease is unclear:
- the amount of tolerable gluten varies among people with coeliac disease.
Although there is no evidence to suggest a single definitive threshold, a
daily gluten intake of <10 mg is unlikely to cause significant histological
abnormalities (1)
NICE suggest that Coeliac disease is believed to be present in up to 1 in 100
of the population although only about 10-15% of people with the condition are
clinically diagnosed (2)
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