Don't jump to conclusions about coeliac disease

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 – a condition where the gut lining is destroyed as a reaction to eating gluten – it is, says Gastroenterologist Dr Joe Geraghty, more that people are ‘self-diagnosing’ and are probably suffering from a variety of other stomach problems.

Which, says Dr Joe Geraghty, could mean they delay getting the correct treatment for their condition.

Here Dr Joe Geraghty who holds regular clinics at Spire Manchester 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 an autoimmune disease in which you develop an allergy to the wheat protein gluten. This leads to an inflammatory response in the small bowel which damages the small, finger like projections (villi) that allow the body to absorb nutrients from food into the blood

There are certain genes that make coeliac disease more likely and it does often run in families.

Without diagnosis and treatment, the villi become inflamed and flattened. In some cases, they can even disappear completely. This is termed 'villous atrophy'. This leads to malabsorption, a condition where the body cannot absorb essential nutrients from food.

What symptoms may a patient have?
Symptoms include diarrhoea, constipation, vomiting, stomach cramps, mouth ulcers, fatigue and anaemia.

How is it diagnosed?  
A Gastroenterologist would carry out a combination of blood tests that are markers of the antibodies causing the damage. This will be followed by an endoscopy where a camera is used to investigate the small intestine and biopsies are taken to allow cells to be studied in detail under a microscope.

Very high antibody levels are almost certainly a sign of coeliac disease but lower levels do not confirm the diagnosis and some individuals do not have measurable antibodies of the correct class, so biopsy is indicated in all cases except young children with high antibody levels. Antibodies can also be falsely raised, for example in patients with autoimmune disease such as diabetes.

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 should make an appointment if they have; any of the symptoms outlined above, anaemia, evidence of malabsorption or a family history of coeliac disease. Untreated coeliac disease can often cause non GI (gastrointestinal) symptoms 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 now rarely see patients severely affected with maldigestion and brittle bones.

What problems can not getting diagnosed create? 
In undiagnosed untreated coeliac disease, patients will continue to have disabling GI symptoms. There is a greater risk of complications including anaemia, osteoporosis and neurological conditions. Furthermore, although rare there is an increased rate of certain cancers.