Coeliac disease is a condition caused by an inability to digest gluten, which often results in bowel symptoms, weight loss or failure to gain weight, and lack of certain vitamins and minerals with consequential problems such as anaemia and osteoporosis.
Diarrhoea and bulky, smelly motions that float often occur in coeliac disease. This results in less nutrients being absorbed from the bowel, and thus weight loss or failure to grow and put on weight in children. Sufferers sometimes have a swollen or bloated belly.
Children with coeliac disease may eat a lot but not put on any weight, or lose weight. (This can also be a symptom of diabetes.)
People with coeliac disease may also develop problems associated with absorbing iron and vitamins less well, such as anaemia which leads to general tiredness and sometimes shortness of breath or fluid retention.
Coeliac disease may cause problems in the bones by reducing the absorption of calcium and vitamin D from food. This may cause osteoporosis or osteomalacia.
As well as the symptoms of the disease itself, people with coeliac disease have a slightly higher risk of certain bowel tumours. It appears that a gluten free diet reduces these risks. It is thus all the more important that people with coeliac disease adhere to their diet and see their doctor for regular follow up.
There is a skin condition with a red blistery rash, known as dermatitis herpetiformis, which is associated with gluten sensitivity. This is also treated by adopting a gluten free diet, although medication is sometimes used in addition.
It seems that the genes in some people predispose to coeliac disease. The result is that sub-sections of the proteins (peptides) found in wheat, in gluten and gliadin, become toxic to the lining of the gut (the mucosa).
Your doctor is likely to arrange a blood test to check for anaemia and also a special blood test (anti-gliadin antibodies and/or endomysial antibodies). You may also have a specimen of your motion or stool tested at the laboratory to exclude infection.
If the blood test is abnormal, your doctor will arrange for you to see a specialist (gastroenterologist), who is likely to arrange to look inside the stomach and duodenum, taking specimens (biopsies) from the lining of the duodenum. This shows a typical worn-down sort of appearance, which returns to normal if a further biopsy is taken after a period of excluding all foods from the diet that contain gluten.
If the blood test is not quite conclusive, your doctor may suggest adding extra bread to your diet for six weeks and repeat the blood test. This is likely to make the test positive in someone who is sensitive to gluten.
The key to treatment is to exclude foods containing gluten from your food for life. Your doctor may well arrange for you to see a dietician for advice. These days most foods are marked if they are gluten free.
These days, many restaurants can help if you tell them the problem, however, the patient or their parents have to become expert in what they can or can not take.
- Gluten-free cookery: the Complete guide, by Peter Thomson
- A helpful guide to gluten free cookery. Kindle edition.