What causes Coeliac Disease?
It is always caused by only one thing - sensitivity to gluten. Once someone has coeliac disease, they have it for life and so need to have a gluten-free diet for life too.
What Are The Signs And Symptoms Of Coeliac Disease?
Many people who have gluten sensitivity are completely unaware of this, and have no symptoms. The diagnosis is sometimes made by chance when blood tests are taken in connection with investigations for other possible illnesses.
In adults, tiredness is a common symptom due to anaemia or other deficiency in one or more nutrients. With anaemia, the tongue may appear pale and there may be tiredness or a shortness of breath when doing only mild exercise. Other symptoms include an increased bowel frequency, often with the passage of bulky pale motions and abdominal distension or cramps. Less common is a tendency to constipation, and some sufferers have no bowel symptoms at all. Weight loss can occur despite an apparently normal appetite.
In children, symptoms most commonly appear once cereals have been introduced into the diet - typically after around 8 months - and before the age of 5. There is a failure to grow normally, with weight loss, floppy or weak muscles and problems with diarrhoea or constipation. The abdomen may appear swollen most of the time or after meals and the child may appear lethargic and not interested in playing.
Will I Have Any Tests Or Investigations?
Yes - the diagnosis cannot be made without these.
• 1. Blood tests. These usually show anaemia, and may be the first indication coeliac disease is present. Others may show deficiencies in calcium, iron or folic acid. Antibody tests - although not conclusive - can also strongly suggest the diagnosis and indicate the advisability of;
• 2. A small bowel biopsy. Here, a flexible fibreoptic endoscope is passed into the stomach and first part of the small bowel (under sedation) so that the lining of the bowel can be inspected and a sample taken. This is to look for the characteristic change associated with coeliac disease - a 'flattening' of the normal projections called villi which arise from the surface of intestinal cells. (This can also be done without needing an endoscopy by swallowing a special capsule on the end of a narrow tube that takes a small sample before being withdrawn again.) If the biopsy is found to be abnormal, another test may be advised several weeks later to assess the progress of treatment.
What Treatment Might I Need?
Drugs should not be needed in the treatment of coeliac disease since the problem disappears if gluten is excluded from the diet. This means all foods should be excluded from the diet which contain barley, rye, wheat and oats. The exclusion of oats is sometimes contentious among doctors but most advise omitting them as many oat brands contain a degree of gluten. As can be imagined, it can be very difficult to exclude gluten 100% since it is present in so many foods, but gluten-free foods are available on prescription and a detailed list of other foods which can safely be eaten is available from the UK Coeliac Society.
What Course Will The Illness Follow?
Since the potential effect of gluten on a coeliacs intestine is lifelong, a gluten-free diet will be needed for life as part of a change in lifestyle. The vast majority of sufferers remain extremely well as long as they stick to their diet. Potential complications include a greater tendency to osteoporosis (bone thinning), and fertility problems in women with untreated gluten sensitivity. This resolves once gluten is removed from the diet.
There is occasionally an associated skin condition that can appear before the diagnosis is known. This is called dermatitis herpetiformis and is a very itchy blistering rash, usually affecting the back, knees, elbows and buttocks.
Can I Do Anything To Help Myself?
It is obviously vital that a strict diet is followed, and sufferers of coeliac disease soon learn how any lapse in this affects them. The Coeliac Society is extremely useful in offering practical support and advice to people with gluten sensitivity and should be contacted once the diagnosis is made. Their address is; Coeliac Society of the UK, PO Box 220 High Wycombe, Bucks. HP11 2HY Tel: 01494 437 278
Tell Your Doctor
1. Have you lost any weight or had any bowel problems recently?
2. Do your symptoms seem worse after eating certain foods?
3. Do you feel tired all the time?
4. Have you any unusual rashes?
5. Does any of your family have coeliac disease?
Ask Your Doctor
1. Does coeliac disease increase my risk of bowel cancer?
2. If I appear to have no symptoms from occasionally eating gluten, can I keep doing this?
3. Should my children be tested for coeliac disease?
4. Does gluten sensitivity ever develop for the first time in old age?
5. Do I have to pay for my gluten-free food on prescription?
By Dr Roger Henderson, MB BS Lond., LMSSA Lond.