Coeliac disease: then and now

Today – Coeliac UK has more than 50,000 Members and still funds a wide range of research projects.

2005 – Largest global coeliac diseaseA condition where a person is unable to eat gluten as it makes their body attack itself. and dermatitis herpetiformisUsually shortened to DH, this is a form of coeliac disease where the skin is affected with small blisters. research programme ever funded by Coeliac UK. Thanks to generous legacies, the Charity gave £760,000 to four research projects around the world.

2000s – An explosion in understanding the mechanisms that cause gut damage in coeliac disease has intensified the search for treatments other than the gluten-freeWhen a food has less than 20 parts per million (ppm) of gluten so it is safe for people with coeliac disease to eat. diet. Studies are even underway to see if coeliac disease can be prevented. The future is bright.

1990s – Population screening studies using blood tests showed coeliac disease to be one of the most common lifelong diseases in the Western world with around 1 in 100 people living with the condition.

1980s – The ability to take bowel biopsies using fibreoptic endoscopes and the development of reliable blood tests help to diagnose the condition more easily.

1970s – The genetic markers for coeliac disease are found.

1968 – Foundation of The Coeliac Society (now Coeliac UK) by Elizabeth Segal and Peter Beneson. The aim was to promote better glutenA protein that is found in the cereals wheat, barley and rye. -free foods and address the wider interests of those with the condition.

1965 – Recognition of dermatitis herpetiformis, an itchy skin rash, as a manifestation of coeliac disease.

1957 – Development of the "Crosby capsule" used to obtain biopsies. Used for 25 years until invention of fibre-optic endoscopes.

1956 – Quick and safe jejunal biopsyA small sample of tissue is taken from the upper part of the lining of the gut that is affected in coeliac disease. It is then examined very closely under a microscope. A biopsy will often be taken during an endoscopy. through the mouth developed by Margot Shiner.

1954 – John Paulley, a physician from Ipswich showed the gut changes occurred in coeliac disease with the flattening of villion on the gut surface, resulting in a flat mucosa.

From the mid 1950s, coeliac disease could be easily diagnosed and treated. New procedures and awareness of symptoms catapulted understanding of the disorder.

1950 – Willem Dicke, a Dutch paediatrician, published his MD thesis in which he showed that removal of wheat from the diet caused the symptoms of coeliac disease in children to disappear.

How Dicke linked coeliac disease to wheat consumption has been widely discussed. One theory is that it was connected to the limited supply of wheat products in the Netherlands during World War II. Dicke noticed during this time that coeliac children fed other foods improved. As wheat consumption resumed after the War, these children deteriorated and symptoms returned. While this is an interesting story, it is not the whole truth because it is known that Dicke suspected that wheat was the damaging agent long before the War. His suspicions were aroused as early as 1932 when he attended a medical meeting and heard the story of a child with the disorder who always developed diarrhoea when he ate bread and rusks. This observation stimulated years of careful study that were to prove his theory.

The use of the gluten-free diet transformed the lives of children and adults with coeliac disease and is still the cornerstone of treatment.

1924 – The famous banana diet recommended by Haas was used extensively for many years until the introduction of the gluten-free diet. In Britain during World War II children with coeliac disease were allocated supplies of dried bananas as a supplementary ration.

1888 – Publication of Samuel Gee’s paper, On the Coeliac Affection. He described the features with remarkable accuracy and even suggested that, “if the patient can be cured at all, it must be by means of diet”. He experimented with various diets and noted that, "A child, who was fed upon a quart of the best Dutch mussels daily, throve wonderfully, but relapsed when the season for mussels was over: next season he could not be prevailed upon to take them".

Sir Leonard Parsons, Professor of Diseases of Children in Birmingham, paid tribute to this paper and wrote, "Certainly it is true that whenever people believe that they have discovered some new fact in coeliac disease, a reference to this classic cameo has a chastening effect, for time after time, they will find that their discovery has been forestalled".

During the following years many articles appeared about coeliac disease in medical journals and books, mainly writing about the clinical features of the disorder. Manipulation of the diet was the mainstay of treatment for coeliac disease, as it was for many other conditions a century ago, and restrictions were placed on the intake of fats, carbohydrates and dairy products. Several doctors noted that bread aggravated symptoms but no one made the link to the cause of coeliac disease until Dicke’s ground breaking observations.

1887 – Marked the beginning of the modern era in coeliac disease. Samuel Gee drew attention to coeliac disease in a lecture at the Hospital for Sick Children, Great Ormond Street, London.

1737 – Description of “white flux” by John Bricknell.

1669 – Book published describing a diarrhoeal illness by Vincent Ketelaer, a Dutch physician.

2nd Century AD – First description of coeliac disease by Aretaeus. He described the characteristic stool and noted that it was more common in women than men and that children could also be affected.

Thank you to Dr Geoff Holmes, Member of Coeliac UK’s Health Advisory Council for providing this history.