Coeliac disease (Spelt ‘Celiac’ in Some Countries) is pronounced ‘see-liac’, is commonly regarded to as a food allergy or intolerance, however it is actually an autoimmune disease caused by eating gluten. Autoimmune disease means the body mistakenly attacks healthy tissue, in this cause it is the villi in the small intestine. Eating gluten damages the lining of the small intestine and other parts of the body may be affected in the long term. Villi are the small finger-like projections that line the small intestine and they play a significant role in food digestion. People with coeliac disease make antibodies against gluten so even a small amount can trigger an immune reaction in people with the condition.
When the villi are damaged and inflamed, they are unable to absorb food properly, this means that the food and nutrients are not properly digested which often causes diarrhea, malnutrition and other health problems. If coeliacs is left undiagnosed or if a strict gluten free diet is not followed after a positive diagnosis; those with the disease can have an increased level of developing other associated diseases. These include osteoporosis, depression, infertility, increased risk of certain forms of cancer, such as lymphoma of the small bowel and other autoimmune diseases such as type 1 diabetes, thyroid disease, rheumatoid arthritis, inflammatory bowel disease, Sjogren’s sydrome and lupus.
Even small amounts of gluten can cause harm. The only treatment is to avoid all gluten-containing foods. This allows the bowel lining to recover. This strict attention to diet must be lifelong.
Risk factors for coeliac disease
People are born with a genetic predisposition to developing coeliac disease. They inherit a particular genetic make-up (HLA type), with the genes DQ2 and DQ8 being identified as the ‘coeliac genes’. Other genes and environmental factors also play a role.
In many cases, the condition will not have been diagnosed in other generations. However, a first-degree relative (brother, sister, parent or child) of a person with coeliac disease has about a 10 per cent chance of also having the condition. Coeliac disease affects at least 1 in 100 Australians. Contrary to popular belief, coeliac disease affects all ethnic groups and is found in Europe and North America, as well as in South America, Southern Asia, North Africa and the Middle East. It is most commonly found in countries where wheat plays a large part in the everyday diet.
Diagnosis of coeliac disease
The first step to diagnosis is discussing the symptoms with a doctor. A blood test should then be carried out in order to detect the presence of antibodies which are produced in response to digesting gluten. Your doctor may arrange further tests to detect nutritional deficiencies, such as a blood test to detect iron levels as anemia can often occur with coeliac disease. Since the symptoms of other conditions can closely mimic coeliac disease, correct diagnosis can only be made by showing that the bowel lining is damaged.
If the results are positive, your doctor will refer you to a gastroenterologist. This specialist may confirm the diagnosis by performing a gastroscopy, a procedure that allows tiny samples (biopsies) to be taken from the small intestine. This procedure occurs while you are under sedation the doctor will insert an endoscope (a thin hollow tube) through your mouth into your small intestine. This is the best way to confirm if you have coeliac disease.
Please do not try to self-diagnose coeliac disease. If the blood tests and endoscopy are to reflect a genuine result, you must not put yourself on a gluten-free diet beforehand. These tests are dependent on a normal gluten intake. Many people have negative results to the test for coeliac disease however they still suffer from the same symptoms whenever gluten is digested. In this case, they may have had false negative tests. In order to ensure that you do not have false negative tests for coeliacs disease, you need to continue eating gluten until the tests have been completed. Abstaining from foods containing gluten will prevent the immune system form producing the antibodies necessary for detection in the blood test. Abstaining from gluten prior to the biopsy may also cause the villi in the small intestine to show signs of repair making it difficult for the gastroenterologist to make a conclusive diagnosis of coeliacs disease.
Things to remember
· Coeliac disease is an intolerance to gluten in food.
· A proper diagnosis is essential.
· Even small amounts of gluten can damage the lining of the small intestine (bowel), which prevents the proper absorption of food nutrients.
· Damage can occur to the small intestine even when there are no symptoms.
· There is no cure, but the disease can be managed by a lifelong gluten-free diet.
· A person with coeliac disease can still have a nutritious, balanced and varied diet.
· Consult with your doctor, dietitian or state coeliac organisation.
Where to get help
· Your local GP doctor
· Dietitians Association of Australia Tel. 1800 812 942
· Coeliac Australia Tel. 1300 458 836