Coeliac Disease
Introduction
Coeliac disease is an autoimmune disorder triggered by a protein found in wheat, barley, rye and oats. The presence of gluten triggers inflammation in the small intestine. This affects the ability of the gut to absorb nutrients. An autoimmune disease means the body tends to ‘damage itself’ when gluten is present in the diet. It affects around 1 in 100 people and has a genetic predisposition.
What are the symptoms of Coeliac Disease ?
It can come on at any age, but in children classically in the early years when breads and cereals are added to the diet. The typical symptoms are irritability, weight loss, diarrhoea and abdominal distension. However in many cases the symptoms can be quite subtle. In older children altered bowel function, recurrent or chronic abdominal pains and slowing in growth may occur. Some people with coeliac disease have very little symptoms.
How is coeliac disease diagnosed ?
Screening blood tests are becoming more and more specific and sensitive. However there are still false positives and negatives which means the only true diagnosis is by an endoscopy performed by a gastroenterologist. This is a procedure that requires a mild anaesthetic. A small bowel biopsy it taken and this will confirm the diagnosis. Unfortunately this testing requires the person to be taking gluten, at least 4 slices of bread per day for 6 weeks.
How is coeliac disease diagnosed ?
Genetic markers (these are called HLA DQ2 and HLA DQ8) are found in 100% of those with coeliac disease. However they are also found in one third of the population. So the only useful result is if these markers are absent when tested. This means the person tested cannot have coeliac disease at any stage. First degree relatives (sibling, parent, child,) have about 10% chance of having coeliac disease. Identical twins have a 70% chance if one is diagnosed.
What is the Treatment ?
The only treatment is a gluten free diet. This means ensuring gluten intake is less than 20parts per million. This will have a dramatic affect on symptoms and ensures there are no chronic nutritional deficiencies.
What are the complications of eating gluten containing foods ?
Some people do not have many symptoms, and are frustrated at having to be on such a strict diet. However they can have complications related to subtle malnutrition such as osteoporosis, infertility, skin problems and there is a definite risk of small bowel lymphoma.
Where can I get more information ?
The best place is Coeliac Australia at http://www.coeliac.org.au
What about gluten intolerance (non-coeliac gluten sensitivity) ?
Many alternative health professionals advise gluten free diets. In fact if you believe half the claims made by some, going off gluten will cure everything from migraines, behavioural problems, psychiatric disturbances and even cancer. There is absolutely no evidence for these claims for those who do not have coeliac disease. However there is no doubt that some people ‘feel better’ when they adopt a gluten free diet. What has happened here is they have adopted a partial ‘FODMAPS’ diet. This diet has been shown to have a dramatic affect on those adults with vague gastrointestinal symptoms which fall under the umbrella of irritable bowel syndrome or IBS. Wheat products have a number of carbohydrates that are responsible for many symptoms of IBS and are excluded when adopting the FODMAPS diet. So when someone adopts a gluten free diet they cut down on many other associated products found in cereals which cause such symptoms. But is not the gluten that is causing the symptoms.
