Coeliac Disease

Coeliac Disease is an intestinal disorder caused by intolerance to gluten, a component of wheat, rye, barley and oats. Gluten contains a protein called alpha-gliadin. In people with Coeliac Disease, this protein causes damage to the mucous lining of the intestine, thus impairing the body's ability to breakdown and absorb vital nutrients. This leads to deficiencies of vitamins, folic acid, iron, calcium, carbohydrates, proteins, and fats. Without these essential nutrients, malnutrition will occur despite an adequate diet.

Coeliac Disease can affect adults and children. The first signs are usually diarrhoea, weight loss and anaemia. Other signs include nausea, abdominal bloating, large and frequent pale or light yellow foul smelling bowel movements that float; depression, fatigue, irritability, muscle cramps and wasting; and joint or bone pain. Sometimes there is also a red itchy skin rash (dermatitis herpetiformis). Young children and infants may have stunted growth, vomiting, poor appetite and mouth ulcers.

Those with Coeliac Disease may have an increased risk of osteoporosis, and bone density tests are advised. Coeliac Disease also causes malabsorption of B Complex vitamins especially folic acid, vitamin B6 and B12; the fat soluble vitamins A, D, E and K and the minerals iron, calcium, selenium and zinc.

Diagnosis

This relies upon proving that the small bowel lining shows the typical abnormality of coeliac disease (villous atrophy). This can only be done via a small bowel biopsy test (endoscopy). A specific panel of blood tests measuring antibodies to gluten is also available. For both children and adults positive diagnosis should be confirmed by repeating the above procedures 6 to 12 months after starting a gluten free diet.

Long-term risks of undiagnosed coeliac disease

Chronic poor health, osteoporosis due to calcium malabsorption, infertility, miscarriages, depression, dental enamal defects and an increased risk of gastrointestinal and oesophageal carcinoma have been listed as possibilities. In children, lack of proper development and behavioural problems may present.

Treatment

Treatment is by lifelong adherence to a gluten free diet. By removing the cause of the disease, this treatment allows all abnormalities, including that of the bowel lining, to recover completely. At the beginning of treatment it may be necessary to replace current nutrient deficiencies. Some people may have a transient intolerance to lactose (the sugar found in milk) and may be advised to temporarily restrict lactose from their gluten free diet.

Labelling of foods

If unsure about the gluten content of any food, follow the general rule: when in doubt, leave it out. The Australian Food Standards Code requires that good labelled as gluten free must not contain any detectable gluten and no oats or malt. Food labelled as low gluten must contain less than 0.02% gluten.