Things you need to know about coeliac disease

We recently spoke with Consultant Gastroenterologist, Dr Matthew Johnson, surrounding coeliac disease, the warning signs, and what can be done to help you.

I have previously heard coeliac disease being called “a tiger in the rough” and “a great pretender”. It is because the condition doesn’t always cause symptoms and when it does they can be mild and don’t always seem to be related to the digestive tract. It is an auto-immune disease caused by a reaction towards gluten, which is contained in wheat, barley and rye.

This auto-immune disease is said to affect 1% of the UK population. Many people are asymptomatic at diagnosis, while others bumble along with vague symptoms of tiredness or what has been “fobbed off” as IBS (irritable bowel syndrome). Traditionally we are taught that coeliac disease patients are thin and suffer from diarrhoea, but the reality is that tiredness and constipation are the most common symptoms, and being overweight does not preclude you from this condition.

It's not surprising therefore, that the average delay to diagnosis is 13 years {1}. The problem is that the longer the condition is left unchecked, the higher the risk of developing other associated conditions. Just from malabsorption alone of iron and folate (seen in 29%), patients can develop anaemia or tiredness {2}. Vitamin D deficiency can lead to thinning of the bones from osteopenia and osteoporosis (50% at diagnosis) {3}. Hyposplenism affecting 80% can leave people more susceptible to picking up infections {3}. Diabetes and thyroid abnormalities become more common the longer the condition remains poorly controlled (23% after 10 years) {4}. There are also some rare, but more worrying associations such as the premalignant ulcerative jejunitis and small bowel T-cell lymphoma.

The good news is that virtually all of this is controllable and reversible with a gluten free diet. While initially any diet can seem restrictive, it is becoming easier to adjust to this with the ever expanding number of gluten free products on the supermarket shelves and with most good restaurants now catering specifically for coeliac patients. Sports stars like Djokovic have shone a light on gluten free diets and made them trendy, not just for coeliac disease, but also for IBS sufferers as well.

As a doctor, the frustrating thing is that this is a relatively easy thing to diagnose. A simple TTG (tissue transglutaminase) blood test can give you a rough idea whether you may have the condition with 96% sensitivity {4}.

If you suspect it, check it.

For further advice visit Coeliac UK.

To book a consultation with Dr Johnson, please call our friendly self-pay team today on 01582 788 412 and they will happy to help.

Sources:

{1} Coeliac UK 04/05/2018 - https://www.coeliac.org.uk/document-library/5232-undiagnosed-at-risk-with-delays-in-coeliac-disease-diagnosis/.

{2} MW Johnson. Gut. July 2017. PWE-137. The prevalence of anaemia in coeliac disease.

{3} MW Johnson. Nat Clin Pract Gastroenterol Hepatol. 2008;5(12):697–706. Celiac disease in the elderly.

{4} Ventura A (1999) Gastroenterology 117:297-303.

{5} Rostom A. Gastroenterology. 2005 Apr;128(4 Suppl 1):S38-46.