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Dr Paul Froomes - Consultant Physician & Gastroenterologist - Coeliac Disease

Coeliac Disease

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.
Last Updated ( Wednesday, 18 February 2009 )