As Nutritional Therapists we are all aware of the problems linked to gluten exposure, from wheat allergy, non-coeliac gluten sensitivity and coeliac disease, yet at times it can be difficult to convince other clinicians of the increased frequency of diagnosis and the benefits of exclusion diets. The GP magazine Pulse has created a very useful resource site for Drs to explore current conventional thinking, the site is interesting and informative and if you have to write to a GP requesting investigative tests then it may well prove to be a useful referral site for their information expansion.
Coeliac disease is caused by a heightened immunological response to gluten in genetically susceptible people. Once triggered, the disease process can only be treated by eliminating gluten from the diet for life.
Historically, coeliac disease was believed to be uncommon; however, population-based studies have now revealed that it occurs more often than previously thought. In the UK, the prevalence of coeliac disease ranges between 0.8% and 1.9% – although only 10-15% are diagnosed.
The prevalence of coeliac disease is considered to be greater in people with autoimmune conditions, such as type 1 diabetes or autoimmune thyroid disease, and in first-degree relatives of people with coeliac disease.
|•||Type 1 diabetes – approximately 2-4% are affected by coeliac disease|
|•||Autoimmune thyroid disease – approximately 2-4% are affected by coeliac disease.|
|•||First degree relatives – 5-19% incidence|
|•||Increased incidence in patients with Down’s syndrome|
|•||Selective IgA deficiency – approximately 10% are affected by coeliac disease|
Coeliac disease is traditionally associated with gastrointestinal symptoms (such as diarrhoea, abdominal pain, bloating, constipation and indigestion), because chronic inflammation of the small intestine is a feature of the immune response to gluten.
In fact, symptoms for coeliac disease may be similar to irritable bowel syndrome (IBS) and consequently misdiagnosis with IBS may occur.
However, non-gastrointestinal features of coeliac disease are increasingly being recognised in people presenting with the disease.
Delayed diagnosis is a concern as it means the symptoms of coeliac disease remain untreated and because of the possible long-term effects of undiagnosed coeliac disease.
Small bowel cancer and osteoporosis, for example, are complications of undiagnosed coeliac disease. Once on a gluten-free diet, the patient’s risk of malignancy is reduced to that of the general population. However, the increased risk of osteoporosis in the coeliac population persists due to less effective absorption.