Wednesday 28 September 2016

Dr Ciara Kelly: Many people have Coeliac disease and are blissfully unaware

Coeliac disease is so common that as many as one in a hundred suffer from it, but it's under diagnosed

Ciara Kelly

Published 13/07/2015 | 02:30

Zooey Deschanel is affected by coeliac disease.
Zooey Deschanel is affected by coeliac disease.

I met a very interesting woman recently on holidays, who had a rash on her upper arm. It was a patch of blisters that looked not unlike a cluster you'd see in shingles. But it was actually a condition called dermatitis herpetiformis - nothing to do with herpes but looks not unlike it. She'd had it for a good while and several different treatments had been tried, before she was sent to a dermatologist who diagnosed it - and then asked her how long she'd had coeliac disease.

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"I don't have coeliac disease" she replied. "Oh yes you do!" said the dermatologist. (We doctors relish those moments that make us look accidentally clever) And it struck me that there may be many people out there who have a similar rash and are blissfully unaware of the fact that they're coeliac.

Coeliac disease is a common condition, affecting one in a hundred of us but the average time from symptoms first presenting until diagnosis is 13 years! It is not a food intolerance or food allergy, it's an auto immune condition that causes the body to react to gluten, a food found mostly in products containing wheat, but also barley, rye or, in some cases, oats. So that would be foods such as breads, pasta, cake and beer.

The body produces antibodies to the gluten, reacting to it almost like it's a germ, and this causes lots of inflammation in your small intestine, which affects its ability to absorb nutrients from your food. So people with coeliac often suffer with anaemia, vitamin deficiencies, weight loss, fatigue and weakness. And if they're children they may fail to grow or thrive.

People may also have gastrointestinal symptoms - so they can suffer from pale or bulky stools or smelly diarrhoea. They may have abdominal bloating and wind or pains that come and go. If the symptoms are mild, diagnosis is often delayed. And even though most cases were once diagnosed in childhood now the majority of new cases are adults.

Coeliac disease is especially common among families. So if you have a relation with it, your chances of coeliac are increased to one in 10.

Diagnosis is by blood tests checking for antibodies to gluten, and also by biopsy of the gut. (Which shows inflammation and a flattening of the gut lining - preventing proper food absorption)

But in the case of the lady mentioned above, those tests were merely confirming the diagnosis given by the presence of her skin rash. If you're found to be coeliac, you should also then be tested for vitamin deficiencies and anaemia and may also need a DEXA scan to check your bone strength.

Coeliac is under diagnosed so even if you have no symptoms you should still be screened if you have a family member with it, have other autoimmune conditions like Type I Diabetes Mellitus, Thyroiditis or have Down Syndrome.

Treatment for coeliac disease is a gluten-free diet. This basically means avoiding all foods with gluten - and doing so for the rest of your life. It is - no question - a lifestyle restriction, as even small amounts of gluten, for example, the amount in a communion wafer, can be enough to cause the inflammation in the gut to persist. People with coeliac may also need iron, calcium, vitamin D or other supplements to address any deficiencies they might have and to protect their bones.

Coeliac's very common -the film star Zooey Deschanel is reportedly among those who suffer - and loads of people don't know they have it. If any of you have a relative with it, abdominal symptoms, fatigue or a rash like the one above, head down to your GP for starters for the blood tests.

Gluten-free food has come a long way and is now widely available in low-cost supermarkets. At yeast give it some thought . . . Apologies for the rye humour.

@ciarakellydoc

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