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What is Coeliac Disease ?

Coeliac disease is a condition by which a protein called gluten, damages the small intestine, impairing the absorption of food. Gluten is found in the cereal grains wheat, barley, rye and oats*. The small intestine recovers and returns to normal when gluten is withdrawn from the diet. The incidence of coeliac disease in the UK is now believed to be between 1 in 100, although it is thought that at least 60% are undiagnosed. *Oats do not actually contain gluten but a very similar protein called avenalin. Many individuals with coeliac condition may be able to tolerate oats whilst other individuals may need to avoid them. The majority of oat products are contaminated with wheat, rye or barley and therefore making them unsuitable for a coeliac diet.

What are the Symptoms of Coeliac Disease ?

Symptoms vary between individuals. In infants, coeliac disease typically presents as failure to thrive and in children it can present as loss of appetite, diarrhoea, constipation and anaemia. With the adult population it can present at any age and with a wide variety of symptoms including: diarrhoea (50%), iron or folate deficiency anaemia (80%), chronic tiredness and lethargy (80%), other abdominal symptoms (bloating, flatulence, distension) (30%) and weight loss (50%). At one time, it was thought that coeliac disease only presented with severe symptoms, being exclusively diagnosed in those individuals who were acutely ill. However, it has become apparent over the past twenty years that some patients diagnosed with coeliac disease can present with very mild symptoms. Some studies have suggested that up to 70% of patients diagnosed with coeliac disease only have abnormal blood test results, such as mild anaemia and/or vitamin deficiencies.

How is Coeliac Disease Diagnosed ?

If coeliac disease is suspected, a blood test is carried out. If this test is positive an endoscopy will be undertaken at the local hospital. This usually takes place in an outpatient clinic and involves a small camera being placed into the small intestine to examine the lining. A small sample is also taken to be studied under the microscope, confirming the diagnosis of coeliac disease. As well as the endoscopy, a blood test is usually carried out to identify any mineral and vitamin deficiencies.

What is the treatment ?

Treatment for coeliac disease is a life long gluten free diet. The sources of gluten can be divided into two sections:

The obvious sources which include wheat, barley, rye and oats, usually found in the form of flour. Therefore ordinary bread, pasta, cakes, biscuits, pastries, puddings and pies should be avoided. The hidden sources include ingredients used in packaged food and drink. These can be the most difficult to avoid. Wheat flour is commonly used as a processing aid, a binder, filler or as a carrier for flavourings and spices. Foods can also become contaminated with wheat flour during manufacture, and patients with coeliac disease should check food labels for hidden sources.

What Help is available to Achieve a Completely Gluten Free diet ?

Firstly, you should be referred to a state registered dietitian. They will be able to explain the diet to you and offer you practical advice on how to follow the diet. Coeliac UK is a registered charity for people suffering from coeliac disease. They produce information on gluten free foods and can offer advice and information on all aspects of the condition. They will also be able to provide information on local coeliac groups that provide an opportunity to meet with others with coeliac disease. There are a wide range of gluten free specially manufactured products available to help replace those foods that must be avoided. These include breads, pasta, cookies, biscuits and pizza bases.

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