Wednesday 13 December 2017

Could my daughter have coeliac disease?

Ask the GP...

Abdominal discomfort is a very common complaint, particularly in children
Abdominal discomfort is a very common complaint, particularly in children

Nina Byrnes

Advice from our GP on what steps to take if you think your child is a coeliac and information on ulcer causing Helicobacter pylori.

Q. My daughter is constantly complaining about her stomach. She is 10-years-old and seems to get constipated easily. It's a battle to get her to drink enough but she does eat her veg. She frequently complains of reflux too, which is worse when she eats wheat/gluten, so we've excluded it from her diet for now, to see if she improves. The reflux subsides and flares up again when she eats wheat/gluten. Are the two things connected and should I get her tested for coeliac disease?

Dr Nina replies: Abdominal discomfort is a very common complaint, particularly in children. Constipation is extremely common in this age group and is the most common cause. Many children are fussy eaters and are not consuming adequate fibre and fluids in their diet to keep things moving regularly.

True wheat or gluten sensitivity is a medical condition. It is better known as coeliac disease. If a person with coeliac disease eats gluten-containing foods the lining of the intestine becomes damaged and loses its ability to absorb nutrients effectively. Undiagnosed this can lead to poor nutrition and gastrointestinal upset.

Symptoms include diarrhoea, constipation, fatigue, mouth ulcers, anaemia, indigestion, abdominal pain and bloating, mood changes, bone pain and fertility issues. Coeliac disease is an autoimmune condition and you cannot catch it from someone else. It does have a genetic link and if one member of a family is affected, then there is a one in 10 risk that another member of the family will develop it.

Coeliac disease is more common in Irish caucasian populations. Other autoimmune conditions such as diabetes and thyroid disease may also be found more commonly in those with coeliac disease. Lactose intolerance may also occur as a damaged small intestine may not be able to break down lactose effectively. This however can improve once a gluten-free diet allows the lining of the gut to recover.

Coeliac disease can be diagnosed using specific tests. In order for these to be accurate it is necessary to consume a diet that contains gluten for the previous six weeks. Blood tests look for specific antibodies that are raised in coeliac disease. If these are positive then a gastroscopy test and biopsy of the gut lining can confirm the diagnosis. If symptoms are typical and the blood tests are negative a doctor may advise the gastroscopy anyway. The treatment is a gluten-free diet.

There are many foods that contain gluten. Most people are aware that it is necessary to avoid wheat, barley and rye and foods containing these such as pasta, but gluten may also be contained in many sauces, snacks and even some cosmetic products such as lip balm or lipstick.

Thankfully now there are gluten-free alternatives to many foods, these are stocked in most supermarkets and expenses can be claimed back against tax. Many restaurants now also offer gluten-free alternatives.

It is important to follow a gluten-free diet as failure to do so can lead to malnutrition; osteoporosis and also can increase the risk of cancer of the small intestine.

I advise a visit to the doctor for anyone with chronic gastrointestinal upset. Further tests including those for coeliac disease can be arranged if required, and will clarify for you if symptoms are merely constipation, food sensitivity or an underlying disease process.

What is Helicobacter pylori and how do you know you need to be tested?

It is estimated that over half of the stomach ulcers worldwide are caused by Helicobacter pylori. This is a bacterium that can survive in the stomach. It can weaken the mucus coating that lines the stomach wall allowing an ulcer to develop. Not everyone who has this infection develops ulcers or symptoms and it may be present for many years before an ulcer occurs. Other symptoms suggestive of infection may be acid reflux, nausea, and bloating or bad breath.

Those who have upper gastrointestinal symptoms that haven’t settled with simple treatment will usually be referred for testing.

It is not entirely clear how Helicobacter is transmitted. It can be tested for via a simple breath test, a blood test or directly when having a gastroscopy. Once diagnosed it is treated with a course of two antibiotics and a tablet to block acid production. The course of treatment used to be one week, but more recent studies suggest that a two-week course of treatment may be more effective and this is sometimes recommended. Helicobacter can be hard to treat in some people so it is essential to take all medication as prescribed. A breath test is normally performed at least four weeks after the initial course of treatment to ensure the bacteria is no longer present.

For those who suffer ongoing heartburn despite treatment of Helicobacter infection a longer course or antacid medication may be prescribed. Proton pump inhibitors block the production of acid in the stomach and work on the premise of no acid, no pain. So although it is important to visit your doctor if you experience lingering chest pain, the treatment may be simpler than you think.

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