What is coeliac disease?
Coeliac disease is hereditary and commonly found in individuals of Northern European descent, it can affect people of any background. In fact, it is the most prevalent genetic condition in Europe and in Australia it is estimated to affect about one in 100 people. Coeliac disease is characterised by damage to the lining of the small intestine upon exposure to even trace amounts of gluten, a protein present in wheat, barley, rye, and oats.
Consequently, individuals with this condition experience impaired absorption of food and nutrients, leading to bowel symptoms and deficiencies in essential vitamins, minerals, and other nutrients.
What are the symptoms?
Coeliac disease presents with a spectrum of symptoms, ranging from mild to severe, and some individuals may experience no symptoms at all. While there are no specific symptoms unique to the disease, common complaints include diarrhea, weight loss, nausea, flatulence, and abdominal discomfort. Tiredness and weakness are also prevalent, often due to deficiencies in iron and/or folic acid, which can lead to anaemia. In some cases, coeliac disease may be diagnosed during investigations for osteoporosis.
Less frequently, adults may present with mouth ulcers, recurrent miscarriages, or infertility as initial signs of coeliac disease. In children, the condition often manifests as poor weight gain, delayed growth and development, irritability, and reduced appetite, alongside bowel problems and anaemia.
How is Coeliac disease diagnosed?
Coeliac disease is typically diagnosed through a combination of medical history assessment, physical examination, and laboratory tests. The primary steps in diagnosing coeliac disease include:
- Medical History and Physical Examination: Dr Peerbaccus will inquire about your symptoms, family history, and any risk factors for coeliac disease. He will also conduct a physical examination to check for signs of malnutrition or other related conditions.
- Blood Tests: Blood tests are used to detect specific antibodies that are often elevated in individuals with coeliac disease. The most ordered blood test is the tissue transglutaminase antibody (tTG-IgA) test. Elevated levels of these antibodies indicate an immune response to gluten.
- Genetic Testing: Genetic testing can identify the presence of certain genetic markers associated with coeliac disease. However, genetic testing alone cannot diagnose coeliac disease, as many individuals with these genetic markers may never develop the condition.
- Intestinal Biopsy: If blood tests suggest coeliac disease, an intestinal biopsy is usually performed to confirm the diagnosis. During an endoscopy procedure, a small tissue sample (biopsy) is taken from the lining of the small intestine. The biopsy is examined under a microscope to look for characteristic changes associated with coeliac disease, such as villous atrophy and inflammation.
- Response to Gluten-Free Diet: In some cases, a diagnosis of coeliac disease may be confirmed if symptoms improve or resolve after following a strict gluten-free diet. However, this method is not typically used alone for diagnosis and should be done under the supervision of a healthcare professional.
How is Coeliac disease treated?
The primary treatment for coeliac disease is strict adherence to a lifelong gluten-free diet. This means completely avoiding foods and products containing wheat, barley, rye, and oats, as even small amounts of gluten can trigger symptoms and damage the small intestine. Treatment typically involves the following steps:
- Dietary Changes: Adopting a gluten-free diet is essential for managing coeliac disease. This involves eliminating all sources of gluten from your diet, including bread, pasta, cereals, baked goods, and processed foods containing hidden gluten. Instead, focus on naturally gluten-free foods such as fruits, vegetables, meats, fish, dairy products, legumes, and gluten-free grains like rice, quinoa, and corn.
- Nutritional Supplements: If you have nutritional deficiencies due to malabsorption caused by coeliac disease, your healthcare provider may recommend vitamin and mineral supplements. Common supplements include iron, calcium, vitamin D, vitamin B12, and folate.
- Medications: In some cases, medications may be prescribed to manage specific symptoms or complications of coeliac disease, such as diarrhea, inflammation, or nutritional deficiencies. For example, corticosteroids may be used to reduce inflammation in the intestine, while anti-diarrheal medications can help control diarrhea.
- Regular Monitoring: After diagnosis, it's important to undergo regular follow-up appointments with Dr Peerbaccus to monitor your condition, assess nutritional status, and ensure that your gluten-free diet is effective in managing symptoms and preventing complications. Periodic blood tests and intestinal biopsies may be recommended to monitor disease activity and assess for any ongoing damage to the intestine.
- Education and Support: Living with coeliac disease requires education and ongoing support to successfully manage the condition. Dr Peerbaccus, dietitians, and support groups can provide valuable information, resources, and guidance on adopting and maintaining a gluten-free lifestyle, navigating social situations, reading food labels, and managing potential challenges.
