COELIAC DISEASE

The information on coeliac disease on this website is not designed to provide medical or professional advice. It is designed to provide information only and if you have any health questions or problems please consult a medical doctor.

What is coeliac disease?

Coeliac disease is a condition in which your immune system responds or reacts incorrectly or in an abnormal way to GLUTEN, that is, your body mistakenly thinks that gluten is harmful and your body starts to fight it. Gluten is a protein found in certain foods in particular grains, such as wheat, rye, barley and oats. This incorrect or abnormal response causes damage to the small bowels by destroying and removing the inside lining of the small bowels which is made up of finger-like projections called villi. Villi helps with increasing the surface area of the small bowels that absorbs nutrients from the food.  Once the villi is damaged a number of health problems can happen due to poor absorption of nutrients from the food.

To get coeliac disease you must be born with a genetic defect that makes you susceptible or predisposes you to develop coeliac disease which can affect anyone. Some of the common most genes that are associated with coeliac disease are HLA DQ2 and HLA DQ8. Having this genetic defect does not necessarily mean that you will develop coeliac disease. In Australia 30% of the population carry one or both of these defective genes and only 3% of people carrying these genes will develop coeliac disease. A first degree relative of someone with coeliac disease has a 10% chance of also developing coeliac disease, so screening is advised if you or a close family member has been diagnosed with coeliac disease.

Coeliac disease affects approximately 1 in 70 Australians, yet about 80% of people with coeliac disease do not know they have it and they are living and walking around with no treatment at all. This equates to about 160 000 Australians.

Coeliac disease cannot be cured but it can be controlled and managed well with strict gluten-free diet. Once the gluten is removed from the diet, the villi of the small bowels grow back and normal absorption of nutrients from the food resumes and all problems caused by coeliac disease do not reoccur, but if you start eating gluten containing foods again, symptoms return. It is important to know that there is no relationship between symptoms and the extent of bowel damage from gluten. Therefore if you have coeliac disease, you need to stick, strictly to a gluten-free diet regardless of how severe your symptoms are.

Symptoms of coeliac disease

The symptoms of coeliac disease are variable and they range in severity from feeling well to having severe symptoms. These symptoms include but are not limited to:

• abdominal pain, bloating, constipation, cramping, diarrhea, flatulence, nausea, vomiting, fat in stools
• bone and joint pains
• delayed puberty in children
• easy bruising of the skin
• fatigue, tiredness, weakness
• iron deficiency anemia, vitamin and mineral deficiencies
• mental fogginess or less alert
• mental irritability
• poor growth in children
• recurrent mouth ulcers and or swelling of mouth or tongue
• skin rashes
• weight loss but some weight gain can happen

Importantly, treatment with a strict gluten-free diet leads to small bowel healing, resolution of symptoms and a reduction in the long-term risk of these complications.

It is important to have coeliac disease diagnosis correctly as it is a very important medical condition which involves permanent and significant lifestyle changes. The tests used to diagnose coeliac disease are unreliable if they are undertaken under the wrong conditions such as doing the test after adopting the gluten free diet. Once you know the diagnosis correctly, other causes of your symptoms can be excluded with confidence and proper treatment can be implemented and screening for complications of coeliac disease can done as well as screening for the condition in family members. If your coeliac disease is not detected and remains untreated you will develop complications which include but not limited to:

• autoimmune conditions
• chronic diseases such as diabetes, cancers such as bowel lymphoma
• increased risk of infertility, miscarriage and stillbirth
• liver disease
• mental illness such as depression
• osteoporosis

Coelic disease testing is very easy and involves the following:

1. Keep eating your normal diet (do not try to have gluten-free diet prior to testing even if you are having the symptoms)
2. A blood test to check for coeliac disease antibodies for screening. These antibodies are generally raised in untreated coeliac disease.
3. A small bowel biopsy is done to confirm the diagnosis of coeliac disease. This is done by having a gastroscopy (a camera in the stomach under sedation) which involves taking samples of the lining of small bowels.  A gluten-free diet should only be started after the gastroscopy.

Help

You  are able to get help if you have coeliac disease from various professionals and organizations such as:

1. Doctor
2. Dietician -  Dietitians Association of Australia Tel. 1800 812 942 (https://daa.asn.au)
3. Gastroenterologist
4. Coeliac Australia Tel. 1300 458 836 (http://www.coeliac.org.au) and States organizations

Summary

• Coeliac disease is correctly diagnosed by having a small bowel biopsy during a gastroscopy.
• Coeliac disease is disease where the immune system reacts abnormally to a protein called gluten found in some foods.
• Coeliac disease can be present without symptoms at all and damage to the small bowels can still occur.
• Damage to the lining of the small bowels prevents proper and efficient absorption of nutrients from the food.
• Coeliac disease cannot be cured but it can be managed very well by a lifelong gluten-free diet.