Don't jump to conclusions about Coeliac Disease

14 August 2018

It appears to be the new ‘bad boy’ of all foodstuffs– but how many people presently on a ‘gluten-free diet’ really do need to avoid wheat products at all costs.

Despite there being a major increase in the awareness of coeliac disease – where the small intestinal lining is damaged as a reaction to eating gluten – it is, says Gastroenterologist Dr Dharmaraj Durai more that people are ‘self-diagnosing’ and are probably suffering from a variety of other stomach problems.

Which, says Dr Durai, could mean they delay getting the correct treatment for their condition?

Here Dr Durai, who holds regular clinics at Spire Cardiff Hospital, answers some of the most regularly asked questions about coeliac disease and the possible treatments available.

What exactly is coeliac disease?

Coeliac disease is a condition in which a patient’s immune system responds abnormally to protein gluten.  Gluten is present in wheat, barley, rye, malt, brewer’s yeast and contaminated oats.  This promotes an inflammatory response in the small bowel resulting in a spectrum of changes to the lining of small intestine including villous atrophy.

Villi are small, finger-like projections in the small intestines that help you absorb nutrients. The blunting or flattening of these villi creates a loss of absorptive surface which means your body struggles to take in and process many of the nutrients contained in the food you eat.

How is it diagnosed? 

A gastroenterologist would carry out a combination of blood tests that are markers of the antibodies causing the damage followed by an endoscopic biopsy where a camera is used to investigate the small intestine to allow cells to be studied at close range.

Very high antibody levels are almost certainly signs of coeliac disease but lower levels do not confirm the diagnosis and some individuals do not have measurable antibodies of the correct class so a biopsy is indicated in all cases except young children with high antibody levels. The antibodies can be raised without disease.

Who should be tested?

Coeliac testing should be done in patients with a variety of gastrointestinal symptoms including altered bowel habits, gas, abdominal discomfort, weight loss.  Testing should also be considered even in patients with non-gastrointestinal symptoms like problems with skin, dental, nervous system or fertility problems.  First degree relatives coeliacs, patients with other autoimmune disorders like Type 1 diabetes, thyroid disorders should also be tested.

If people think they may be suffering from it how long should they wait before seeing their GP?

It is not an emergency but patients with untreated coeliac disease often have non GI (gastrointestinal) symptoms as well and these may also respond to treatment.

What treatments are available?

Basically, the main treatment is gluten exclusion. This sounds simple but is quite difficult as wheat flour is so ubiquitous in manufactured foodstuffs.

The advent of the 'free from' ranges in supermarkets has improved things greatly and the gluten-free products have massively improved over the last few years. It is no longer like eating cardboard!

You do need to monitor your progress and occasionally need medicines to support the process and replace deficient vitamins.

Can most people, once correctly diagnosed, lead a relatively normal life?

Definitely, once the diet is under control all sufferers should be able to lead a normal life. We no longer see patients who had prematurely aged with terrible bones.

What problems can not getting diagnosed create?

There is an increased rate of certain gastrointestinal cancers in patients with untreated coeliac disease but these are still rare.  GI symptoms can be disabling and the nutritional deficits can result in anaemia and osteoporosis.  Once diagnosed, strict adherence to a gluten-free diet improves patient’s energy levels, corrects various nutritional deficiencies and improves general well-being.

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