cøliaki

Cøliaki, also known as celiac disease or coeliac disease, is a chronic autoimmune disorder triggered by gluten, a protein found in wheat, barley, and rye, in individuals with genetic susceptibility. The disease primarily affects the small intestine, causing inflammation and damage to the intestinal mucosa and leading to malabsorption.

Genetic predisposition is strong, with most patients carrying HLA-DQ2 or HLA-DQ8 haplotypes. Gluten exposure initiates an immune response that damages the intestinal villi and causes crypt hyperplasia. The condition can develop at any age, often presenting in childhood or early adulthood, and shows a broad spectrum of symptoms.

Symptoms vary. Children often present with failure to thrive, weight loss, diarrhea, abdominal pain, and irritability. Adults may have chronic diarrhea or constipation, fatigue, iron-deficiency anemia, bone pain or osteoporosis, abdominal discomfort, or dermatitis herpetiformis. Some individuals experience non-gastrointestinal symptoms or are asymptomatic.

Diagnosis relies on serology and histology. Screening tests include tissue transglutaminase antibodies (tTG-IgA) and endomysial antibodies (EMA), with measurement of total IgA to assess deficiency. If serology suggests celiac disease, a small-bowel biopsy showing villous atrophy and increased intraepithelial lymphocytes confirms the diagnosis. HLA-DQ2/DQ8 testing can support the diagnosis but is not definitive.

Management consists of a strict, lifelong gluten-free diet, avoiding wheat, barley, rye, and gluten-containing products. Ongoing monitoring includes symptom evaluation and periodic serology; nutritional supplementation may be needed for deficiencies. Education on avoiding cross-contamination is important.

Prognosis improves with adherence to a gluten-free diet. Untreated cøliaki can lead to persistent malabsorption and complications such as iron deficiency, osteoporosis, infertility, and, rarely, certain cancers. The condition is associated with an increased risk of other autoimmune diseases.