Tuxford Health Matters – May 2013 – Coeliac Disease
This month we focus on a topic which is probably under diagnosed – Coeliac Disease (CD). CD is caused by the inflammatory reaction of the small intestine (gut) to exposure to gluten – a protein found in wheat, barley and rye products. It can cause a myriad of symptoms from abdominal pain, and tiredness, to weight loss and anaemia. Once confirmed, the condition will resolve if gluten is excluded from the diet.
What is CD?
CD is NOT an allergy to food, or a food intolerance – it is an autoimmune disease. Affected individuals make antibodies to gluten, mistaking the protein for a germ. These antibodies then cause significant inflammation of the lining of the small intestine, causing the surface to become flat and featureless. Because of this it becomes much less able to absorb nutrients from ingested food, leading to malabsorption (and in turn can lead to weight loss, and anaemia due to failure to absorb vital components needed to make blood such as iron).
How common is CD and who does it affect?
CD affects 1% of the population, but is more common in affected families, and is more common in people with other autoimmune diseases, such as some thyroid diseases, rheumatoid arthritis and type 1 diabetes – active screening of this population whether or not they have symptoms is advised every three years. In the general population, people of any age can develop CD, and it is now most commonly diagnosed in adults aged 40-50 years. 25% cases are diagnosed after the age of 60 years.
What are the symptoms of CD?
In babies it usually presents when they are weaned onto solid foods, presenting with failure to put on weight or grow, diarrhoea, vomiting and abdominal distension.
In children it may present in a similar way, with poor growth, diarrhoea, and symptoms due to deficiency of nutrients, such as anaemia. Symptoms can be atypical and present in an unusual way, making the diagnosis difficult.
In adults it usually presents with anaemia (due to the poor absorption of iron), or with abdominal symptoms such as pain, bloating and diarrhoea. These are also symptoms of IBS (irritable bowel syndrome), so exclusion of CD is part of the investigation of IBS symptoms.
How is CD diagnosed?
If CD is a suspected possibility, then a blood test can be done to try and pick up the antibody in the blood. It is important that the patient has NOT avoided gluten for at least 6 weeks prior to the test otherwise it may be falsely negative. If the test is positive then a camera (endoscopy) test will be arranged at the hospital to confirm the diagnosis by taking a small biopsy from the small bowel and examining under the microscope. Other tests may be arranged looking at nutrient levels in your blood, such as iron, folic acid, vitamin B12, albumin and calcium.
What is the treatment for CD?
The main treatment for CD is total avoidance of gluten for the rest of your life. Fortunately nowadays most food is labelled as to whether is contains gluten – obvious foods include bread, cakes, pastries, pasta and some cereals, but it is often in other less obvious foods such as some ready made meals, where gluten is used as a thickener. Some but not all CD patients are able to eat oats. Coeliac UK (address below) is a useful resource for advice. Gluten-free flour, pasta, bread and other foods are available on prescription, from health food shops, or nowadays in most supermarkets. Prescription items are limited to 12-18 per month, depending on age and sex. Vitamin, iron and calcium supplements may be advised.
Are there any long term complications?
CD is associated with impaired immunity due a less effective spleen, and it is recommended that patients have vaccinations including Hib (haemophilus influenza B), pneumovax (streptococcus pneumonia) and the annual influenza vaccine.
There is an increase risk of osteoporosis due to nutritional deficiencies, an increase in developing other autoimmune diseases, an increase risk of a premature or low birth weight baby if you become pregnant, and increase risk of developing lymphoma (a type of cancer) of the gut (rare and risk very low if you remain gluten free).
If you avoid gluten, you can expect to keep symptom free and have a normal healthy lifespan. Even small amounts of gluten can cause symptoms and increase the risk of complications occurring. This includes the amount of gluten contained in a communion wafer!