diagnosis of coeliac

[Gabes-Apg]

i may be wrong, but i think this article reiterates what us MC'ers have been saying, long terms IBS symptoms are not always IBS, and biospy is the most accurate way to diagnosis Coeliac.....

the list of major and minor symptoms sound familiar.


http://shepherdworks.com.au/disease-inf ... ac-disease

Coeliac Disease
Coeliac disease is a medically diagnosed condition of an intolerance to gluten in the diet. Gluten is the protein component of wheat, rye, barley and oats. In people with coeliac disease, after consuming gluten, the small intestinal lining (villi) becomes inflamed and the normal appearance changes so that it has a flattened appearance. A strict gluten-free diet can reverse these abnormalities, and is the only recognised treatment for coeliac disease.

Prevalence of coeliac disease is likely to be underestimated in Australia, and is probably in the order of 1 in 100, with diagnosis rates increasing. Coeliac disease also occurs in 10% of first-degree relatives. More than 99% of people with coeliac disease have the genetic profile of HLA DQ2 or DQ8.

Presentation
It is becoming increasingly evident that there is indeed a broad spectrum of presentations of coeliac disease. Increasing numbers of adults are being diagnosed, whereas years ago it was considered a disease that was only diagnosed in children. Coeliac disease can present at any age and the variability and often vagueness of symptoms can present a diagnostic challenge to many medical practitioners. Presentation can include:
Gastrointestinal symptoms such as:

Loose stools/diarrhoea, or constipation (or a combination of both)
Flatulence
Bloating
Abdominal pain
Nausea
These can often be labelled as irritable bowel syndrome. It is strongly recommended all people experiencing symptoms of irritable bowel syndrome be investigated for coeliac disease.

Alternatively, it may present with no gastrointestinal symptoms at all.
Other symptoms can include:

Lethargy and fatigue
Poor weight and growth gain in children
Iron, folate, zinc, Vitamin D deficiency.
Osteopaenia and osteoporosis. Approximately 5% of patients being investigated for reduced bone mineral density have undiagnosed coeliac disease as a cause.
Delayed menarche or recurrent miscarriages in women
Infertility (in males and females)
Recurrent mouth ulceration
Dental enamel defects
Diagnosis
The gold standard for diagnosis is a small bowel biopsy (the doctors will look for histological evidence of villous atrophy +/- infiltration of lymphocytes). This involves a special camera being passed down the oesophagus, past the stomach, and into the first part of the small bowel. There, small samples of the lining of the small bowel are taken and investigated under the microscope. If the biopsy samples show flattening of the lining, then it confirms coeliac disease.

There are some blood tests that can be performed to help screen for coeliac disease in “at risk” populations (eg. family members, people with diabetes, etc). However these are generally not ideal for diagnosing coeliac disease, as there can be false positives and false negatives. Blood tests including IgA anti-endomysial or tissue transglutaminase antibody tests can be ordered (“coeliac serology”). Total IgA antibody test should also be performed to help validate results.The small bowel biopsy is still considered the best method for diagnosing coeliac disease.

There is no role for a trial of Gluten-Free diet without a preceeding biopsy.

It is important that people being checked for coeliac disease need to still be eating gluten in their diet. If they cut gluten out of their diet (eg. trial a gluten free diet) before being properly diagnosed, they can reduce their chances of being diagnosed, as the villi/lining can start to repair. If the camera is then inserted to take the samples for biopsy, but the person has already started the diet, the biopsies might show to be normal – but this may not be an accurate result – it could be false as it may be repaired. Therefore, all people who look suspicious for coeliac disease (eg. have symptoms, etc) should still be eating gluten whilst being investigated by their doctor(s).

Coeliac disease is a life-long condition and there is no cure. The only treatment available is a diet free from all gluten. This prevents further damage to the villi and allows them to return to normal, so that nutrients can be properly absorbed. People need to follow the diet even if they are not unwell with symptoms. It must be strict and life long – people cannot take a break every now and then and have a bowl of regular pasta, or a slice of regular bread.

If left untreated, people with coeliac disease can be at an increased risk of bowel cancer, osteoporosis, infertility, miscarriages and chronic ill health. The risk of all of these returns to normal on a gluten free diet.

Once the diagnosis of coeliac disease has been made, the following tests are recommended if not already completed: full blood examination, iron studies, folate, vitamin B12, zinc, vitamin D levels and bone mineral density. They can also have lactose intolerance, fructose malabsorption, problems with their thyroid gland (underactive, overactive), diabetes, etc. These should all be checked in people with coeliac disease.

Ongoing monitoring is important. People’s villi usually grow back and return to normal, but time for this to occur can range from months to years. People need to remain on their diet for life – even if the villi grow back. In this sense, people are only treated, they are not cured. The diet is for life (until a cure is found!! – and the doctors are working on it!)

A gluten-free diet for coeliac disease prevents further damage to the intestinal lining, allowing villi to heal so that nutrients from food can be properly absorbed. The gluten-free diet is a life-long diet, and strict dietary compliance is essential, even in the absence of symptoms. A gluten free diet involves a lot more than just avoiding regular bread and wheat-based pasta. It is very involved. Despite this, there are plenty of foods you can enjoy! As the diet must be strict and life-long, but to also to help ensure you are enjoying your diet safely, it is recommended you see a dietitian with experience in coeliac disease. The Dietitians Association of Australia and the Coeliac Societies can provide details of experienced dietitians.

All people diagnosed with coeliac disease are encouraged to join the Coeliac Society – there are Societies for each State. They are a valuable source of support and new food product information. Members receive a quarterly magazine, handbook and ingredients book. Events such as cooking demonstrations, group dietitian sessions, children’s camps, and social evenings are regularly offered. As information about the gluten-free diet can change over time, maintaining membership of the Coeliac Society should be for the long-term, to ensure ongoing access to up-to-date information. The Coeliac Society of Australia has branches in all states of Australia, and details can be found at www.coeliacsociety.com.au.

The gluten-free diet can be challenging and difficult, especially for the first few months following diagnosis, but it progressively becomes easier with familiarity with the diet and the foods available grows over time. There are many great tastes, gluten free, and the number of foods is increasing every day.

Information about research in coeliac disease can be found at http://www.coeliacresearchfund.org/.

The Coeliac Society of Australia Inc
Po Box 271 Wahroonga, NSW 2076
www.coeliacsociety.com.au