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Celiac Disease
Dr. Sulaiman Bin Yusof
MbChB (Sheffield)
M.Med (Surg)
FRCSEd (Gen Surg)
蘇萊曼·尤索夫博士
Celiac disease is a chronic autoimmune disorder in which the body reacts abnormally to gluten, a protein found in wheat, barley, and rye.
When individuals with celiac disease consume gluten, it triggers an immune response that damages the villi – tiny finger-like projections lining the small intestine. This damage leads to reduced nutrient absorption, which can cause digestive issues and long-term complications, such as malnutrition, anaemia, and osteoporosis.
Symptoms of Celiac Disease
Celiac disease can present a wide range of symptoms that vary among individuals, which include:
Digestive Issues: Diarrhoea, bloating, gas, and constipation are common, especially in children. Adults may experience chronic abdominal pain and discomfort that can affect daily activities.
Fatigue: Chronic fatigue can develop due to poor absorption of essential nutrients, leaving the body undernourished.
Weight Changes: Unexplained weight loss occurs as the body struggles to absorb nutrients from food, leading to malnutrition. In some cases, individuals may gain weight due to inflammation-related water retention or fat accumulation.
Skin Rash: Dermatitis herpetiformis is a skin manifestation of celiac disease, characterised by intensely itchy, blistering rashes. These rashes typically appear on the elbows, knees, buttocks, and sometimes the scalp or back.
Anaemia: Iron deficiency anaemia can result from malabsorption of iron and other nutrients, presenting symptoms like paleness, dizziness, and shortness of breath, which can worsen without treatment.
Causes of Celiac Disease
Celiac disease occurs due to a combination of genetic and environmental factors. Common causes include:
Genetic Factors
Celiac disease is associated with inherited genetic markers, particularly HLA-DQ2 or HLA-DQ8. Individuals with these genes have a higher risk of developing the condition. Coeliac disease has a strong hereditary component, with people who have close relatives with the condition being more likely to develop it themselves.
Autoimmune Conditions
Individuals with other autoimmune disorders, such as type 1 diabetes or autoimmune thyroid disease, are at a higher risk of developing coeliac disease. The presence of one autoimmune condition may make the immune system more susceptible to developing others.
Environmental Triggers
Stress, pregnancy, infections, or surgery can sometimes trigger the onset of celiac disease in genetically predisposed individuals. These factors may disrupt the immune system and initiate the abnormal response to gluten.
Diagnosis of Celiac Disease
Diagnosing celiac disease involves several tests to confirm the condition and assess the extent of intestinal damage.
Blood Tests
Blood tests detect the presence of antibodies associated with celiac disease. Elevated levels of tissue transglutaminase (tTG-IgA) or other relevant antibodies suggest an immune response to gluten.
Genetic Testing
Genetic testing identifies whether a person carries the HLA-DQ2 or HLA-DQ8 genes, which increase the risk of celiac disease. However, having these genes alone is not enough for a diagnosis, as many people with these markers never develop the condition.
Endoscopy with Biopsy
To confirm celiac disease, a doctor may perform an endoscopy to examine the small intestine and take tissue samples (biopsies) to assess damage to the villi.
Treatment Options for Celiac Disease
As a chronic condition, celiac disease treatment focuses on managing symptoms and preventing further damage to the small intestine. Treatment methods include:
Non-Surgical Treatment
Gluten-Free Diet
The primary treatment is a strict gluten-free diet, which requires avoiding wheat, barley, rye, and their derivatives. Safe alternatives include gluten-free grains like rice and quinoa. This diet helps to heal the intestine and prevent symptoms from recurring.
Nutritional Supplements
Supplements such as iron, calcium, vitamin D, and B vitamins may be needed to address deficiencies caused by poor nutrient absorption. These supplements support recovery and help maintain overall health.
Medication
Medications may help manage specific symptoms or complications of coeliac disease. Dapsone or other anti-inflammatory drugs can control the rashes associated with dermatitis herpetiformis. In cases of severe intestinal inflammation or persistent symptoms, steroids or immunosuppressants may be prescribed to reduce immune activity and support healing.
Surgical Treatment
Small Bowel Resection
A small bowel resection involves removing a damaged portion of the small intestine. It may be necessary if complications arise, such as intestinal cancer, obstruction, or ulcers, or if severe intestinal damage occurs. The remaining parts of the intestine are reconnected to allow digestion to continue. This surgery is only considered when dietary changes and medications are not effective.
Managing Celiac Disease
Strict adherence to a gluten-free diet is required to prevent complications.
Regular monitoring of nutrient levels helps address deficiencies early.
It is necessary to avoid hidden gluten in processed foods, medications, and supplements, and to prevent cross-contamination during food handling.
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Dr. Sulaiman Bin Yusof
MbChB (Sheffield)
M.Med (Surgery)
FRCSEd (General Surgery)
蘇萊曼·尤索夫博士
Dr. Sulaiman Bin Yusof is a Senior Consultant colorectal and general surgeon in Singapore with over 15 years of specialist experience across public and private practice. Trained in the United Kingdom and awarded a Ministry of Health Fellowship to the Peter MacCallum Cancer Centre in Melbourne, he has built his practice around complex colorectal surgery, with robotic-assisted technique as his primary surgical platform for colectomy and anterior resection.
Patients consult Dr. Sulaiman for his depth of experience in colorectal cancer and perianal conditions, as well as for consultations that are thorough, unhurried, and focused on giving patients a clear understanding of their options.
Credentials & Fellowship Training
Dr. Sulaiman holds an MBChB from the University of Sheffield, a Master of Medicine in Surgery (M.Med), and a Fellowship of the Royal Colleges of Surgeons of Edinburgh in General Surgery (FRCSEd). He completed a Ministry of Health Fellowship at the Peter MacCallum Cancer Centre in Melbourne, one of the world’s foremost oncology institutions, serves as a Visiting Consultant at Changi General Hospital and has contributed eight peer-reviewed publications to medical literature.
Former Director of Endoscopy, Changi General Hospital
Dr. Sulaiman served as Director of Endoscopy at Changi General Hospital, overseeing one of Singapore’s busiest endoscopy units, and brings that public-sector depth of experience to his private practice. In this role, he led a high-volume diagnostic endoscopy service encompassing colonoscopy and gastroscopy across a broad and diverse patient population.
Academic Appointments & Teaching Awards
Dr. Sulaiman holds concurrent Adjunct Associate Professor appointments at the NUS Yong Loo Lin School of Medicine, Lee Kong Chian School of Medicine, and Duke-NUS Medical School. He has been recognised on the Dean’s Honour Roll for Teaching and received the Singapore Health Quality Service Star Award 2023, reflecting his contribution to both surgical education and clinical care.
Contact Dr Sulaiman: Colorectal and General Surgeon in Singapore
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Frequently Asked Questions
Can celiac disease lead to other health conditions?
Yes, untreated celiac disease can result in complications such as osteoporosis due to poor calcium absorption and an increased risk of certain cancers, including intestinal lymphoma. Strict adherence to a gluten-free diet helps reduce these risks and improve long-term health.
Can celiac disease affect children differently than adults?
Yes, children often experience growth delays, irritability, and digestive issues, while adults may develop fatigue and anaemia from long-term nutrient deficiencies. Early treatment is key to preventing complications and supporting healthy development.
How soon do symptoms improve after starting a gluten-free diet?
Some people experience relief from symptoms within a few days to weeks after eliminating gluten. However, intestinal healing can take several months to years, depending on the severity of the damage.