Articles
Diagnosing Coeliac Disease
Untreated Coeliac disease can lead to many long term health issues, including vitamin and mineral deficiencies, osteoporosis, infertility and an increased risk of cancer. Unfortunately, coeliac disease still seems to be a condition that people ‘self diagnose’ after reading about symptoms on the internet or speaking with well meaning family and friends. Gluten is then unnecessarily removed from the diet without ever confirming the diagnosis and having the appropriate tests. A proper medical diagnosis of coeliac disease is important to ensure the diet is not being restricted unnecessarily and there are no associated deficiencies that require treatment.
If coeliac disease is suspected, the first step is to speak to a doctor. DO NOT stop eating gluten before the coeliac disease testing begins. Eliminating gluten from the diet prior to testing will make the tests unreliable and a real case of coeliac disease may be missed. If gluten has already been removed from the diet, a 6 week gluten challenge will need to be conducted before any tests can be carried out reliably. A minimum of 4 slices of bread containing wheat will need to be consumed daily for 6 weeks to ensure there is sufficient gluten in the diet.
The doctor will then carry out a number of coeliac serology blood tests that measure antibody levels in the blood. These particular antibodies will likely be elevated in someone with untreated coeliac disease. A coeliac diagnosis should not be made solely on a blood test and further investigation is required. Normal levels of antibodies will usually rule out coeliac disease and prevents unwarranted invasive procedures.
If the serology confirms elevated antibodies, the doctor will order a more invasive test, a small bowel biopsy, which will confirm or reject a diagnosis of coeliac disease. A gastroscopy is performed, by which a small optic cable is passed down the throat to give the doctor a view of the small intestinal lining. Biopsies of the lining are also taken for examination under a microscope. A patient with untreated coeliac disease will exhibit the characteristic damage to the small intestinal lining known as villous atrophy.
Although not commonly conducted, coeliac gene testing is available. To have Coeliac disease one must carry either of the genes responsible for its development, HLA DQ2 or HLA DQ8. If neither of these genes is found, coeliac disease is not a possible diagnosis. If either gene is found, this only indicates that Coeliac disease may develop at some point in the future. In fact, only 1 in 30 people who carry the gene will eventually develop coeliac disease. It is for this reason the gene test is not routinely used to diagnose coeliac disease.
Despite this, the gene test is a useful tool in some circumstances. If blood tests and biopsy are inconclusive and cannot rule out coeliac disease, then a positive gene test will give a better indication and a negative gene test will rule coeliac diagnosis out. In addition, gene testing is not dependent on an individual consuming gluten at the time, so a positive gene test in this situation will confirm the need to challenge gluten for 6 weeks before a small bowel biopsy is conducted.
Once a diagnosis of Coeliac Disease is confirmed, a lifelong gluten free diet will be required. This is not as simple as it sounds, even with all the gluten free foods available. Following a strict gluten free diet involves being educated on both the obvious and hidden sources of gluten, as well as how to ensure your diet is not lacking in any important nutrients. Speaking to a dietitian is vital, as they can help ensure your diet remains gluten free whilst ensuring variety and complete nutrition. If coeliac diagnosis is ruled out but symptoms persist, a dietitian may be able to help you discover the source of your discomfort through food and symptom diaries and food eliminations and challenges.
Added to site on : Tuesday, 4 September 2012