Touching Lives - September 2003
New hope for coeliac sufferers
This sensitivity to gluten can cause inflammation and damage to the small intestine and symptoms can include abdominal pain, weight loss and in extreme cases, malnutrition.
The symptoms can be controlled by following a strict gluten-free diet — but Action Medical Research and Sainsbury’s teamed up to fund a three year study into coeliac disease that could help its diagnosis and treatment.
“When I was an undergraduate, it was thought that perhaps one in every 1,800 people suffered from coeliac disease” said Paul Ciclitira, Professor of Gastroenterology at St Thomas’ Hospital, London, and leader of the research team.
“^Now we know that one per cent of the population is actually affected — a huge number of people^ — and though we have come a long way since young children died because the condition went undiagnosed, there is still a lot for us to learn about the way in which it is inherited and how the disease process actually works.”
Coeliac disease is a complete intolerance to wheat gluten, but because its primary symptoms are stomach upsets and gastric pain, it can go unrecognised for some time.
It tends to be hereditary; in fact the research completed by Professor Ciclitira and his team indicates that members of a family where one person is a known sufferer are many times more likely to have the disease than people from families with no known cases.
He said, “In our research we collected blood samples and checked for antibodies that are found only in people with coeliac disease. This was followed up by a small bowel biopsy, to confirm the presence of the disease. We used the blood samples to examine the DNA for genes associated with the development of the condition.
“In the UK there is no routine screening for family members, but our research indicates that it should be considered. In many other European countries screening of relatives is automatic, and here I think it could lead to earlier diagnosis, saving the patient a lot of discomfort and the NHS money in treatments.”
What is the actual process that causes coeliac disease? A particular peptide (a breakdown product of wheat gluten during digestion) has been shown to cause tissue damage in the small intestine of sufferers. This was demonstrated by the team’s research, which has so far involved a number of volunteer patients.
A clearer understanding of this peptide and its action on the small intestine is likely to be critical in determining the exact cause of coeliac disease and its possible prevention.
The study of genes associated with the development of the disease may unearth a way to work with the body’s own immune system to ‘block’ the inflammation altogether and stop the symptoms completely.
A genetic test for coeliac disease may be developed that could replace the more invasive biopsy of the small intestine, which doctors currently rely on and which means that sufferers have to undergo a surgical procedure in hospital.
Just as exciting, the work could lead to a technique to genetically modify wheat, or another cereal crop, so that its flour does not affect coeliac sufferers.
Following ^a strict gluten-free diet inevitably means that things like cakes and pastries are off the menu^. But a flour that does not contain gluten could mean that for the first time coeliac patients may safely be able to eat a sandwich made of something that resembles real bread!
Professor Ciclitira continued, “It has been a fascinating study, like being given the pieces of a jigsaw and having to put them all together. We knew that wheat was the driver and that has allowed us to focus on the mechanism of the disease to find out exactly what’s going on.
“We have had some very good results and it’s important now that more research continues to build on our findings. For example, we investigated the prevalence of coeliac disease in other disorders of the immune system and found that four per cent of patients with conditions such as Lupus (a long-lasting disease of the immune system where the body attacks its own cells and tissues causing a wide range of chronic symptoms) also suffer from coeliac disease. This has never been reported before.”
Geoff Spriegel, Technical Director at Sainsbury’s, is equally pleased with the project’s findings. “An increasing number of our customers are asking for a wider range of gluten free foods. Sainsbury’s is delighted to have supported this innovative project by Action Medical Research which is clearly helping to improve understanding about the causes of coeliac disease. We’re excited by its potential to improve the food choice and product quality for sufferers.”
Help and advice is available from Coeliac UK on 0870 444 8804