Could it be coeliac disease? A GP guide to gluten intolerance
What is coeliac disease?
Coeliac disease is defined as a chronic immune-mediated disorder which is triggered by exposure to gluten. Gluten is the main protein found in wheat, barley and rye.
Who gets coeliac disease?
Coeliac disease affects around 1% in the population and usually occurs in genetically pre-disposed individuals (usually those with a 1st degree relative with coeliac disease). You are also at risk if you or close family members have other autoimmune diseases such as type 1 diabetes and thyroid disease (1).
What are the signs and symptoms?
Symptoms of coeliac disease can vary widely from person to person but most often include persistent unexplained change in bowel habit, tiredness, unexplained vitamin deficiency and in some a unique skin rash called dermatitis herpetiformis.
The charity Coeliac UK provides a self-assessment tool called “Could it be coeliac disease?” On their website that I have linked below (2).
How do you test for coeliac disease?
The main test for coeliac disease used in primary care is called Tissue Transglutaminase Antibody which can be found on a blood test. If it is positive it makes a diagnosis of coeliac disease more likely, however it is not always accurate so your GP may still refer you to hospital as suspected coeliac disease if this is negative.
After this you will be referred to hospital and receive one or both of the following: A blood test for the HLA gene (a gene predisposing to coeliac disease) and/or a colonoscopy (a camera test into the bowel) (3).
A guide to investigations for gut related symptoms can be found on the website “What’s Up With My Gut?”. This website provides explains the pathway for both adults and children (4).
How do you manage Coeliac disease once you have a firm diagnosis?
Coeliac disease is managed by a strict gluten-free diet. You will normally be supported by a dietician when you first get diagnosed. There are also gluten free products available on prescription and I have linked the available products offered in Northern Ireland below (5).
Are there any complications with Coeliac Disease?
Common complications of coeliac disease include an overall feeling of decreased quality of life and it associated with depression and anxiety, so do contact your healthcare professional if you are experiencing symptoms of low mood or panic.
Physically you are more prone to vitamin deficiencies due to poor absorption in the gut but these can be screened for. For older adults it is also good to assess for osteoporosis as the gut has poor uptake of calcium and vitamin D.
Coeliac sufferers do have a slightly higher risk of cancer and in particular lymphoma (cancer of the blood cells) so any unusual symptoms such as frequent infections, pale complexion or easy bruising should be investigated (6).
What support is available for coeliac sufferers?
Coeliac UK is the main charity in the UK supporting people with Coeliac disease. Their tag line is “Living Well Gluten Free” and they provide a number of dietician approved food suggestions and recipes as well as local support groups for peer support (7).
References
https://cks.nice.org.uk/topics/coeliac-disease/diagnosis/assessment/
https://cks.nice.org.uk/topics/coeliac-disease/background-information/complications/
