Mal-absorption of nutrients resulting in malnutrition, osteoporosis, depression, anaemia, infertility and an increased risk of certain forms of cancer (e.g. Lymphoma of the small bowel), are but some of the problems associated with this potentially debilitating disease if it goes untreated. Estimations suggest that approximately one in 100 Australians are afflicted with coeliac disease.

WHAT HAPPENS?

Normally lining of the small intestine is made up of millions of finger-like projections known as “villi”. Aside from contributing to the breakdown of certain nutrients for subsequent absorption, these villi also increase the surface area of the small intestine significantly meaning that there is more area over which these nutrients can be absorbed. In a person suffering from coeliac disease, the lining of the small intestine is damaged resulting in the flattening of the villi. This lowers the available surface area in the small intestine significantly lowering the absorption potential of nutrients from this region resulting in nutritional deficiencies.

Those suffering from coeliac disease often go undiagnosed for a period of time as their symptoms can range from minor to severe depending on the state of advancement of the disease. In the early stages the disease can be mistaken for irritable bowel syndrome (IBS) or a food intolerance.

The most common symptoms in adults and children can include:

People are born with a genetic predisposition to develop coeliac disease. They inherit a particular genetic make-up (HLA type), with the genes DQ2 and DQ8 being identified as the ‘coeliac genes’. Coeliac disease affects Caucasians and west Asians and is uncommon in the Oriental Asian and full-blood Australian Aboriginal population. Environmental factors also play a role.

In many cases, the condition will not have been diagnosed in other generations; however, a first-degree relative of a person with coeliac disease has about a 10 per cent chance of also inheriting the condition.

Those suspected of suffering from coeliac disease should first be referred for a blood test (‘coeliac serology and IgA’). If the results are positive, the next port of call is a referral to a gastroenterologist. The diagnosis must be confirmed by the performance of a gastroscopy, a procedure where tiny samples are taken from the small intestine performed under sedation with an endoscope being passed through the mouth into the small intestine. Correct diagnosis can only be made after damage to the small bowel lining has been confirmed. Trialling a gluten free diet (which alleviates symptoms) doesn’t confirm a diagnosis of coeliac disease. Both the blood test and endoscope procedure referred to above are the only definitive tests.

The only treatment for those suffering from coeliac disease is a gluten- free diet for life. This allows the villi to recover.

So common is the incidence of coeliac disease is that a whole range of gluten-free foods can easily be sourced for suffers. Suffers of coeliac disease need to become “ingredient aware” of foods they consume. The services of an accredited practising dietitian (APD) can be invaluable in this respect.