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Coeliac Disease

In people living with coeliac disease, the body reacts to gluten.  This affects the lining of the small bowel and reduces the surface area available to absorb nutrients. Various gastrointestinal symptoms and some potentially serious complications can arise as a result. The only treatment is lifelong avoidance of dietary gluten.

About coeliac disease 

Coeliac (pronounced seel-ee-ak) disease is an autoimmune disease. The body mistakes dietary gluten for a harmful substance and produces antibodies to fight it, as if reacting to an infection. This reaction leads to inflammation and damage to the tiny, finger-like projections that line the bowel (villi), which become flattened. Over time, this reduces the surface area available to absorb nutrients and minerals, and can lead to nutritional deficiencies and gastrointestinal symptoms.

According to Coeliac Australia, coeliac disease affects approximately 1 in 100 Australians but this may just be the tip of the iceberg. It’s believed that 75 percent of cases currently remain undiagnosed. This means that approximately 160,000 Australians have coeliac disease but don’t yet know it.

.coeliac disease

About gluten 

Gluten is a common protein found in wheat, rye, barley and oats. It gives dough an elastic/rubbery texture which aids in baking.

Following is a list of items that traditionally contain gluten and may be unsuitable for a person living with coeliac disease. But there are an increasing number of gluten-free products on the shelves so always make sure to check the labels.

Foods that traditionally contain gluten

  • Bread and breadcrumbs
  • Cakes
  • Biscuits
  • Pastry
  • Pizza
  • Pasta

Products manufactured from a gluten source

  • Beer
  • Some processed meats eg sausages
  • Cornflour (wheat derived)
  • Stocks and gravies
  • Icing sugar mixture
  • Mayonnaise, vinegars, mustards and pickles
  • Many foods labelled ‘wheat free’ (which may have other cereals in them, such as barley or rye)
  • Some medications

It can be difficult to identify items that contain gluten. If you are diagnosed with coeliac disease, it is a good idea to become as ingredient-aware as possible. This can include:

  • Looking out for gluten-free labelling
  • Checking the ingredient list of packaged products
  • Seeking the guidance of an accredited practising dietitian and/or organisations such as Coeliac Australia
  • Using resources such as the GlutenSwitch filter in our FoodSwitch app.

GlutenSwitch, developed by Bupa in partnership with The George Institute for Global Health, can help you find out whether a food product contains gluten. It can also show you other similar products which are gluten free. And just because a food item is gluten free doesn’t mean it’s healthy, so gluten-free alternatives are listed in order of healthiness.

GlutenSwitch is part of our free FoodSwitch app.  To find out more, download FoodSwitch today for your Apple or Android device.

Causes of coeliac disease 

Almost all people known to be affected by coeliac disease have the same genetic markers. This means they are genetically predisposed toward developing coeliac disease and this predisposition runs in families. If you have coeliac disease, it is recommended that your close relatives be screened for it.  They have about a 10 percent chance of also having it.

A person’s environment may also play a role in developing coeliac disease throughout life. For example, research suggests that infants who have repeated infections before six months of age may be at greater risk of the condition. It also provides some support for parents to be cautious of feeding infants gluten in large amounts after weaning.

Symptoms of coeliac disease 

Coeliac disease can cause minor to severe illness, or no symptoms at all.  The latter doesn’t mean the lining of the bowel is unaffected. Some of the more common symptoms include:

  • Tiredness
  • Flatulence/bloating
  • Diarrhoea or constipation
  • Abdominal cramping/pain
  • Nausea/vomiting
  • Weight loss
  • Bone/joint pain
  • Nutritional deficiencies eg low iron levels
  • Dermatitis herpetiformis.

Dermatitis herpetiformis is a severe, itchy, blistering rash that usually occurs on the skin of the elbows, knees, and buttocks. It is considered to be a sign of immune system reaction to gluten in people living with coeliac disease. In children, there can be emotional, physical and developmental issues.

Diagnosis of coeliac disease 

Coeliac disease can be difficult to diagnose because some of its symptoms can mimic other conditions, such as food intolerances and irritable bowel syndrome (IBS). This means doctors can’t rely on symptoms alone to diagnose it. If you are concerned that you have coeliac disease, it is important to discuss your symptoms with your doctor before trialling a gluten free diet. If you start eating a gluten-free diet before being tested, the results may be unreliable.

Accurate diagnosis of coeliac disease involves two stages.  Initially, you have blood tests for certain antibodies which are usually elevated in people with untreated coeliac disease.  The second stage is a biopsy of the small bowel. This is because changes to the lining of the small bowel caused by coeliac disease are not visible to the naked eye.  The specialist needs to examine biopsies (small samples of tissue) under a microscope to confirm damage is present.

The biopsies are taken using a simple day procedure called gastroscopy.  The specialist passes a flexible instrument through the mouth into the small intestine to take a small sample of cells for examination. It usually requires light sedation.

Treatment of coeliac disease 

At the present time, there is no cure for sensitivity to gluten. Avoiding foods containing gluten is the only way to treat coeliac disease. This ‘gluten-free diet’ removes the cause of the immune reaction, allowing the small bowel lining to heal over time. Symptoms can disappear in as little as 2-3 weeks after gluten is cut out completely.

A repeat of the gastroscopy is recommended a year or two after diagnosis to confirm that the bowel is healing.

Read more about a gluten free diet.

Complications of coeliac disease 

If coeliac disease is left undiagnosed and untreated, complications can include:

  • general chronic ill health
  • osteoporosis
  • increased risk of infertility, miscarriage and stillbirth
  • depression
  • liver disease
  • some autoimmune conditions
  • certain cancers, such as bowel lymphoma.

The good news is that in most cases, a gluten-free diet can, over time, return the risk of developing complications back to normal for you.

Coeliac disease and osteoporosis

The digestive problems in coeliac disease can result in insufficient dietary calcium intake. When bones lose calcium and other minerals faster than they can replace them, it can lead to a loss of bone density. Over time, without treatment, the bones can become fragile and brittle, leading to a higher risk of fracture than in normal bone. This is a condition known as osteoporosis.

If you are diagnosed with coeliac disease, your doctor will recommend you have your bone mineral density measured. Bone mineral density can improve through a gluten-free diet, but it may not return to the normal range. Talk to your doctor about steps you can take to maintain or improve your bone density alongside dietary measures.

Introducing more weight-bearing exercise in to your routine may help. Weight-bearing exercise is activity done on your feet so you bear your own weight, such as walking, dancing, and even tai chi. Your doctor may also recommend you take a specific medicines such as calcium supplements.

Living with coeliac disease 

Coeliac disease can affect your daily activities. A gluten-free diet can be strict and may have a big impact on social aspects of life such as dining out or travelling. The information available from an accredited practising dietitian and/or support groups such as Coeliac Australia can help with making the transition to gluten-free living. See the websites listed below in the Further Information section.

Coeliac disease is a lifelong condition that needs to be managed properly. People living with coeliac disease need ongoing checkups with their doctor or gastroenterologist (a digestive health specialist).  Regular checkups help ensure that the gluten-free diet is helping to manage the condition and keep them healthy.

Further information 

Coeliac Australia

www.coeliac.org.au

Digestive Health Foundation via Gastroenterological Society of Australia

www.gesa.org.au

Sources 

  • Bai J, Fried M, Roberto G, Schuppan D, Farthing M, Catassi C, et al. World Gastroenterology Organisation practice guidelines: celiac disease. 2012. Available from: http://www.worldgastroenterology.org.
  • Better Health Channel. Coeliac disease. [Internet]. 2013 [updated 27 February 2013]. Available from: http://www.betterhealth.vic.gov.au.
  • Coeliac Australia. Catering for those with coeliac disease. [Pamphlet]. No date. Available from: http://www.coeliac.org.au.
  • Coeliac Australia. Coeliac disease [pamphlet] 2011. Available from: http://www.coeliac.org.au.
  • Coeliac Australia. Coeliac disease [internet]  No date [updated 2011]. Available from: http://www.coeliac.org.au.
  • Coeliac Australia. Osteoporosis and coeliac disease [pamphlet]. 2009. Available from: http://www.coeliac.org.au.
  • Dellsperger P, Shepherd S. Clinical update: management guidelines for coeliac disease. No date. Available from: http://www.coeliac.org.au.
  • Digestive Health Foundation c/- GESA. Information about Coeliac Disease [pamphlet]. 2011. Available from: http://www.gesa.org.au.
  • Lee A, Ng D, Diamond B, Ciaccio E, Green P. Living with coeliac disease: survey results from the U.S.A. Journal of human nutrition and dietetics: the official journal of the British Dietetic Association. 2012;25(3):233-8.
  • Myleus A, Hernell O, Gothefors L, Hammarstrom M, Persson L, Stenlund H, et al. Early infections are associated with increased risk for celiac disease: an incident case-referent study. BMC pediatrics. 2012;12:194.
  • van der Windt D, Jellema P, Mulder C, Kneepkens C, van der Horst H. Diagnostic testing for celiac disease among patients with abdominal symptoms: A systematic review. JAMA. 2010;303(17):1738-46.

Last updated: 30 April 2013

Disclaimer
This information has been developed and reviewed for Bupa by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It should be used as a guide only and should not be relied upon as a substitute for professional medical or other health professional advice.

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