Dr Peter Saul, an allergy specialist, describes coeliac disease as a sensitivity to glutens present in wheat, rye and oats which causes inflammation in the lining of the small bowel.

The symptoms of gluten intolerance are sometimes vague, making the condition difficult to diagnose. Sometimes referred to as an allergy to wheat or gluten, it can seriously reduce the quality of life of people affected.

How does gluten allergy interfere with digestion?

Inside the small bowel there are tiny finger-like structures called villi which assist in the absorption and digestion of food and nutrients. With coeliac disease, inflammation from the intake of gluten causes these villi to die. This means a person with coeliac disease is unable to absorb food properly.

Symptoms of coeliac disease include:
• Diarrhoea
• Stunted growth
• Tiredness and other symptoms of anemia

What are the problems with diagnosing coeliac disease?

Dr Saul estimates that approximately 1 in 100 people in western countries like Britain suffer from coeliac disease but less than half of them have been diagnosed by doctors. Problems in diagnosis arise because at first the symptoms are generally too vague for the sufferer to consider seeking professional help for.

This is problematic because if left untreated coeliac disease can increase a person’s risk of bowel cancer or at the very least sufferers will feel unwell if the disease is not treated properly.

How is coeliac disease diagnosed?

There are simple blood tests that any doctor can do that can screen for coeliac disease. A person suffering from tiredness, bowel disturbances, an inability to gain weight properly, and unexplained anemia should consult their GP.

If the blood test comes back positive the patient will be referred to a gastroenterologist who will take a biopsy of the small bowel using a telescopic machine. The machine is inserted into the mouth and travels down through the stomach into the small intestine. Once the biopsy has been analysed under a microscope and the diagnosis confirmed the person can begin treatment.

Is coeliac disease hard to manage?

In Britain anybody diagnosed with coeliac disease will be referred to a dietician. The dietician will go through the type of diet a person with coeliac disease will need.

Follow up appointments will take place to monitor:

• Calcium levels, as people with coeliac disease can suffer from low calcium which can cause thinning of the bones
• Growth and weight gain
• Nutrient intake

The dietician is considered the most important member of the team in the management of people suffering from coeliac disease.

Is it difficult to stick to a gluten free diet?

One of the roles of the GP is to help coeliac patients become aware of items offered on prescription that help people manage their disease. In addition, a dietician will also introduce the person to the gluten-free ranges offered in most supermarkets that are very good for coeliac sufferers and provide products such as chocolate biscuits not offered on prescription.

Dr. Peter Saul, MB ChB DRCOG DCH MRCGP, Allergy Specialist

10003 September 2011