How Common is Coeliac Disease?

• Common in adults and children
• Age of onset from 12 months to 90+ years
• Affects up to 1% of the population, mostly Caucasians, Middle Eastern and West Asians
• Long-term risks include osteoporosis, poor growth, infertility, miscarriage, iron deficiency, twice the overall mortality rate, and twice the risk of GI tumours.

Consider Coeliac Disease in:

• Iron, folate, or B12 deficiency ± anaemia
• Tired all the time
• Diarrhoea, constipation or combination
• Abdominal pain, indigestion, bloating, wind
• Unexplained gastrointestinal symptoms. Particularly if the patient also has:
• Coeliac disease in the family
• Thyroid disease
• Type 1 diabetes mellitus
• Down Syndrome
• Abnormal liver tests
• Osteoporosis
• Undefined neurological disorder/epilepsy
• Infertility/recurrent miscarriage

Testing for Coeliac Disease is done by a simple blood test

• Ask for “coeliac serology and IgA” (one serum tube)
• Interpretation: Endomysial antibody (EMA) (IgA) or Transglutaminase antibody, (TTG) (IgA) have high specificity
• Anti-gliadin antibodies (AGA) (IgG & IgA) are less specific

Beware of false negatives due to:

• IgA deficiency (2% coeliac disease, transient deficiency common in children)
• Gluten-free diet (tests negative after >3 months diet)
• Children <2 years – EMA/TTG may not be positive
• High suspicion e.g. family history, anaemia

Do not start gluten-free diet until the diagnosis is confirmed

• Treatment is by strict life-long gluten-free diet
• Education by experienced dietitian recommended
• Membership of local Coeliac Society helps with diet.

Long-term medical follow-up is advisable

Test for:

• associated conditions (e.g. thyroid, osteoporosis)
• family for coeliac disease

After Coeliac Disease Testing

Initial action

• Institute a gluten-free diet (referral to a dietitian)
• Assess for micronutrient deficiency – iron, folate, B12, calcium, vitamin D correct with supplements
• Assess bone mineral density
• Advise screening of family members (see over)
• Letter to patient for Coeliac Society stating diagnosis

Follow Up

• Support long-term dietary compliance
  – Dietitian support
  – EMA/TTG/AGA (loss of antibodies indicates dietary compliance)
  – Duodenal biopsy (at 6 -12 months after diagnosis)

• Follow up on micronutrient deficiencies

• Follow up on osteopaenia/porosis (bone density scan at 12 months)

• Weight & measurement of growth in children and adolescents

Role of the Dietician

(experience in coeliac disease considered essential)

• Educate re food selection, food labels
• Tailor dietary advice to individual needs
• Ensure adequate nutritional intake
• Determine need for dietary supplements
• Can take lead on provision of follow-up care

Benefits of long-term dietary compliance

• Better well-being, improved vitality, improved mental function
• Coeliac disease is strongly associated with osteoporosis. Compliance with a gluten-free diet, together with calcium and vitamin D supplements, protects against further bone loss
• It may also significantly increase bone mineral density, even in the early stages of treatment
• Compliance with a gluten-free diet may result in conception when coeliac disease is the cause of infertility
• Long-term dietary adherence protects against gastrointestinal malignancy
• Non-Compliance is associated with active enteropathy, symptomatic disease and long term complications.