DESPITE the common symptoms of bloating, diarrhoea, weight loss or anaemia, most Australians with coeliac disease remain undiagnosed.
Dr Purnima Bhat… gastroenterologist and a senior research fellow at the ANU Medical School.
Coeliac disease is caused by immune cells in the gut reacting to the protein gluten, found in wheat, barley, rye, oats and other grains. In response to gluten, immune cells concentrate in the intestinal walls of affected patients and cause serious inflammation and damage.
While about 1.4 per cent of Australians have true coeliac disease, wheat allergy and non-coeliac gluten sensitivity affect up to 1 in 10 people.
The risk of developing coeliac disease is inherited. However, since these genes are also common in people who don’t have coeliac disease, it suggests some additional environmental trigger is required.
People with a close family member who has coeliac disease have a 10 per cent chance of having the disease themselves.
Coeliac disease can develop at any age including in children, and even in people who previously tolerated gluten for years.
Around 90 per cent of people with coeliac disease in Australia will have antibodies to gluten protein detectable in blood tests. In addition, investigation by endoscopy is vital to diagnosis and assessment of disease progression.
During an endoscopy, a fibre-optic camera is passed through the mouth into the oesophagus, then stomach and into the small intestine where biopsies can be taken. This procedure is performed with patients sedated and is safe and comfortable.
Complications from untreated coeliac disease can be serious and include nutritional deficiencies, poor immune function and an increased risk of immune cancer such as lymphoma.
Most coeliac disease will be effectively treated by strictly eliminating all dietary sources of gluten, although it can take months for the symptoms to finally improve on a gluten-free diet.
Gluten can be hidden in packaged foods and sauces and seeing a dietician can be beneficial. The long-term outcome for people with coeliac disease is excellent with adequate disease management and careful monitoring.
Non-coeliac gluten sensitivity (NCGS) is a condition that is not well understood. It differs from coeliac disease in that patients have no detectable gluten-related antibodies and no inflammation in the intestine, although symptoms may still improve on a gluten-free diet. It is important that patients with suspected NCGS are adequately assessed for coeliac disease before commencing a gluten-reduced diet as the monitoring and treatment of NCGS and coeliac disease is vastly different.
If you think you may have coeliac disease or NCGS, see your family doctor, who may order blood tests and, if necessary, refer you to a gastroenterologist.
Dr Purnima Bhat is a gastroenterologist and a senior research fellow at the ANU Medical School.
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