Coeliac disease is a chronic autoimmune disorder triggered by ingesting gluten, a protein found in wheat, barley and rye, affecting approximately one per cent of the global population. In individuals with coeliac disease, consuming gluten triggers an immune response that damages the lining of the small intestine, causing symptoms like abdominal pain, bloating, diarrhoea or constipation.

Specifically, this damage leads to blunting of the villi, finger-like projections of the intestinal lining essential for nutrient absorption, leading to weight loss, iron deficiency anaemia and fatigue.

In some individuals, symptoms do not develop until late in life, when a lot of damage has already occurred: it is estimated that up to 90 per cent of those with coeliac disease remain undiagnosed. If left untreated, long-term complications include degeneration of physical and mental health and the development of certain cancers. Unfortunately, there is no cure for coeliac disease yet – strict adherence to a gluten-free diet is the only effective treatment to manage symptoms and prevent complications.

Biomedical scientists are crucial in diagnosing coeliac disease. Point-of-care and laboratory blood tests detect the presence of anti-tTG antibodies, indicative of the autoimmune response to gluten. A definitive diagnosis requires an endoscopic biopsy (a medical procedure where a small tissue sample is taken from inside the body using a thin, flexible tube with a camera) to observe the characteristic damage to the intestinal villi under the microscope.

Coeliac disease is often mistaken for other gluten-related disorders like non-coeliac gluten sensitivity (NCGS) and wheat allergy. NCGS has similar symptoms to coeliac disease but is usually less severe, does not involve an autoimmune response or intestinal damage, and lacks a definitive laboratory test for diagnosis. Wheat allergy, meanwhile, is an allergic reaction to wheat proteins, causing symptoms ranging from hives and swelling to anaphylaxis.

Coeliac disease is a chronic autoimmune disorder triggered by ingesting gluten, a protein found in wheat, barley and rye

MABS’ STEM Engagement project ‘Beat the Wheat’, carried out from June 2023 to July 2024, was financed by the National STEM Community Fund of Esplora Interactive Science Centre (MCST, now Xjenza Malta) on behalf of the National STEM Engagement Working Group.

This project, led by fellow biomedical scientist Stephanie Meli, aimed to raise awareness about coeliac disease while highlighting the critical role of biomedical scientists in its diagnosis.

Biomedical scientists conducted free coeliac disease screening tests, and citizens were asked to fill in online awareness questionnaires. Potential patients were advised to seek further diagnostic follow-up.

Understanding coeliac disease is crucial for ensuring that affected individuals receive accurate information and appropriate care, improving their quality of life and long-term health outcomes.

Jeanesse Scerri is a biomedical scientist currently serving as president of the Malta Association of Biomedical Scientists (MABS), a non-profit organisation dedicated to promoting the biomedical science profession.

Sound Bites

•        The discovery of wheat as a cause of coeliac disease may be partly attributed to the Dutch famine during World War II. Dutch paediatrician Willem-Karel Dicke, who had long suspected wheat as the main culprit, noticed a drop in mortality of his young coeliac patients, from 35 per cent to almost zero, linked to the shortage of bread. Their symptoms returned immediately when bread became available once more. In the 1940s and 1950s, Dicke went on to develop the gluten-free diet, saving the lives of countless children.

•        Having a blood relative with the disease increases the risk that you can develop it as well. Almost all individuals with coeliac disease have genetic markers called HLA-DQ2 or HLA-DQ8. However, only two to five per cent that carry these genes develop coeliac disease, attesting to the complexity of this condition.

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DID YOU KNOW?

•        Gluten was first identified as the protein in wheat in the early 19th century by Italian chemist Bartolomeo Beccari (1682-1766).

•        The first gluten-free commercial product was introduced in the 1980s, paving the way for the gluten-free market explosion.

•        Foods labelled as ‘gluten-free’ are certified to contain less than 20 parts per million (ppm) of gluten, which is internationally considered as safe for individuals with coeliac disease.

•        Individuals with type I (insulin-dependent) diabetes and other autoimmune disorders are at a higher risk of being also coeliac.

For more trivia, see: www.um.edu.mt/ think.