What is it?
Auto-immune |
T-Cell mediated enteropathy of S.I. CD lasts a lifetime. Consumption of gluten flattens the villi (finger-like projections where a lot of nutrient absorption happens) & inflammation = nutrient malabsorption |
Reduces production of enzymes - lactase, sucrase, maltase |
S/S
persistent unexplained gastrointestinal symptoms (N/V/D/bloating) |
Easy bruising |
mouth ulcers |
abdominal pain |
steatorrhea (fatty stools) |
Delayed growth or weight loss |
iron, vitamin B12 or folate deficiency |
Dermatitis herpetiform (skin rash) |
Prolonged fatigue |
Growth failure |
Infertility |
Anxiety, poor memory, headache, depressed mood |
Comorbidities
T1DM |
autoimmune thyroid disease |
IBS |
autoimmune liver disease |
Sjogren disease (autoimmune condition affecting moisture-producing glands) |
Screening
Blood Test |
Immediate relatives of someone with CD have a 1 in 10 risk |
Diagnosis
Diagnosis made only by a gastroenterologist |
1. Keep eating gluten (other test results may not be accurate - min of 6 weeks) |
2. Blood screening. tTG-IgA and DGP-IgG antibodies OR tTG-IgA and total IgA level |
3. S.I biopsy - gastroscopy/endoscopy |
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Intervention
Ensure official diagnosis prior to intervention |
Only treatment is long-term GF diet |
Strategies
Edu: |
Label reading. Wheat vs gluten. Cross-contamination, GF certification, "may contain" |
At home |
labelled GF container, separate spreads/colanders/toasters, prepare gluten free meals first |
Eating out |
Tell staff. avoid foods fried in the same oils, ask them to prepare on a separate board/clean utensils. Take prepared foods with you |
Apps |
Celiac Australia, Find me gluten free |
Support |
Join Facebook groups – recipes and support |
Gluten
wheat |
barley |
rye |
oats |
semolina |
malt barley |
spelt |
couscous |
durum |
Thickeners 1400-1450 |
Wheat maltodextrin (thickener) |
GF Grains
almond meal |
quinoa |
rice |
rice noodles |
rice porridge |
rice crackers |
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Monitoring
At risk nuts: iron, calcium, folate and Vit D |
Review appointment. Every 3-6 months until well. Symptom free = every 1-2 years |
Bloods: tTG, DGP, total IgA, Thyroid Function tests; liver enzymes |
2 years after diagnosis - Duodenal biopsy |
Every 5 years - Bone density scan - risk of osteopaenia/osteoporosis |
Oats
Have a similar protein to gluten called avenin. Can trigger the same immune response in some (5-10%) pts w/ CD |
Australia & NZ: Oats can not be labelled GF - can still use wheat free uncontaminated, pure |
Coeliac Australia: "pure oats are safe and well tolerated by the vast majority of people with CD" |
"pure oats" = free of wheat, rye and barley contamination |
Lactose intolerance
Common in untreated CD - a brush boarder enzyme |
GF diet allows lactase production to return to normal and the lactose intolerance to resolve |
Guidelines & References
Montoro-Huguet et al. Iron deficiency in Celiac disease: prevalence, health impact and clinical management. NutrientsLinks to an external site., 2021 |
Ludvigsson et al. Diagnosis and management of adult coeliac disease: guidelines from the British Soc of Gartoenterology |
Handbook p178 |
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