The prevalence of coeliac disease in Finland is among the highest in the world, and recent research indicates that it is on the rise.
Researchers from the University of Tampere estimate that the prevalence of the autoimmune condition in Finland is around 2.4 percent of the population, compared to approximately 1.4 percent globally. In 2000, this figure was 2.1 percent in Finland.
Though the disease is widely recognised, the Finnish Coeliac Society estimates that up to 70,000 Finns may have it without being aware of it.
Coeliac or celiac disease is a condition where gluten, found in certain grains, damages the lining of the small intestine and causes inflammation in the gut. Some patients also experience skin symptoms. The disease affects those who have a genetic predisposition to it.
"The overall risk of developing the disease is influenced by multiple genes. Enterovirus infections, especially in childhood have also been identified as a probable contributing factor in the onset of the condition," Pilvi Laurikka, a specialist doctor at the Finnish Coeliac Society said.
Currently, there is no medication for the condition, and the only treatment is a lifelong gluten-free diet. Symptoms of coeliac disease can include diarrhoea, abdominal pain, bloating, flatulence, and constipation. The most well-known long-term consequence of untreated coeliac disease is osteoporosis, or bone loss.
Symptoms and intestinal damage can also occur in individuals adhering strictly to a gluten-free diet due to the presence of trace amounts of gluten in gluten-free foods.
The exact causes of coeliac disease's onset remain unclear. Like most autoimmune diseases, coeliac disease is more common in women than in men.
Promising new drugs on horizon
As part of an international coeliac disease study, recent research at the University of Tampere investigated how a new drug compound, ZED1227, can inhibit the enzyme responsible for triggering the disease mechanism in the small intestine.
"This drug compound can effectively prevent gluten molecules from becoming toxic in the patient's intestine," explains Keijo Viiri, who leads the research team at the University of Tampere.
In coeliac disease, the enzyme transglutaminase 2, which is naturally present in the intestine, modifies gluten from grains into a form that triggers inflammation. The drug molecule blocks this process. In the study, an oral medication remained effective even 24 hours after administration.
Roughly 50 milligrams of gluten is enough to trigger an inflammatory reaction in someone with the condition. Viiri believes that the new drug could eventually provide relief, especially as a supplement to dietary management.
"It could be particularly beneficial for patients when travelling. They wouldn’t need to worry as much about what they’re eating. It would be especially useful for those with persistent symptoms and mild intestinal damage.
The research will next move to late-phase trials with a larger patient population, including participants from Finland.
Globally, around 30 drug or vaccine candidates for coeliac disease have been explored over the decades.
ImmunogenX, an American company, is advancing a trialled drug that uses an enzyme to break down gluten in the intestine, similar to lactase supplements for lactose intolerance. A Japanese pharmaceutical company is investigating a drug aimed at preventing the presentation of toxic gluten to white blood cells to avoid inflammation.
Dietary treatment remains primary therapy
According to Viiri, the drug being researched in Tampere might be available for patients within five years, pending broader studies confirming its efficacy and safety, similar to the American preventive drug. Antigen-based drugs, however, will take longer to develop
Despite the availability of new medications, Laurikka maintains that dietary treatment will remain a central approach to combat the condition.
Until 2016, patients in Finland received a monthly dietary reimbursement through Kela to offset the high costs of managing the disease. The government plans to reinstate this reimbursement for minors and low-income adults, with the Ministry of Social Affairs and Health set to review the issue in 2024.
Laurikka hopes for enhanced long-term monitoring of coeliac patients and advocates for better support for those struggling to adhere to the restrictive dietary regimen.
"I hope that the healthcare system, through research and evidence, will better identify patients who truly need additional healthcare and psychosocial support for managing their disease," she said.
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