Coeliac Disease is a multi-system condition often resulting in lengthy and challenging roads to diagnosis. With wide ranging, and diverse symptoms often mimicking other medical conditions such as irritable bowel syndrome (IBS), colitis and other forms of inflammatory bowel disease, getting the right diagnosis can take time.
**What to do if you have concerns?**
If you are suffering from any of the symptoms of Coeliac Disease discussed in our last article, then it is vital that you discuss them with your GP as soon as possible. Your GP will take a detailed history to enable them to make a judgement about whether your condition could be Coeliac Disease.
**Screening and Diagnosis**
Screening for Coeliac Disease is a two stage process which includes:-
– A blood test
– A biopsy of the small intestine
Your GP will be able to arrange for the blood test as the first screening. At this stage it is vital that gluten is still part of your diet as the blood test is specifically looking for antibodies to gluten that are usually present in the bloodstream of people with Coeliac Disease. If you are avoiding gluten when the blood test it taken this could lead to an inaccurate result.
If the result of the bloodtest is positive for Coeliac Disease antibodies, your GP will then refer you for a biopsy to confirm the diagnosis. This stage of diagnosis will be carried out by a consultant Gastroenterologist in a hospital.
A biopsy is a medical procedure where a small sample of tissue is taken from the body so that it can be examined under a microscope to look for the presence of a disease or condition. If you are referred for a biopsy to test for Coeliac Disease, the gastroenterologist will be taking a small piece of tissue from the small intestine – the area of the gut known to be affected in Coeliac Disease.
When someone has Coeliac Disease, the surface area of the small intestine will be inflamed and damaged. The tissue biopsy can highlight this damage and confirm a diagnosis.
To gain access to the tissue in your small intestine, a small thin tube called an Endoscope will be inserted into your mouth, and gently passed through to the small intestine. The gastroenterologist will then pass a small biopsy tool through the endoscope which will take very small tissue samples from your small intestine. The biopsy samples will then be sent away to be examined under a microscope.
If blood tests and biopsy results come back as positive for Coeliac Disease, your GP or gastroenterologist may also want to perform some additional tests to ascertain how much the condition has affected your health. These additional tests might include:-
– Blood tests to check for nutrient deficiencies such as iron or folate anaemia
– A skin biopsy if dermatitis herpetiformis is an issue
– Bone scans – if malabsorption has been an issue for a long period of time, it can cause bone density to be weaker than normal. A bone scan will check the strength of the bones and allow for treatment, if required.
**Post Diagnosis – What now?**
A diagnosis of Coeliac Disease can be very daunting, but, for some, can also be a relief. Knowing how to manage the symptoms you may have been experiencing for months, or even years, can provide some comfort.
The only treatment for Coeliac Disease is to follow a lifelong gluten free diet. Removing gluten from your diet should be attempted in conjunction with support from your healthcare professional team which may include a Dietitian.
A gluten-free diet is one that removes all sources of gluten including wheat, barley and rye. Foods such as semolina, durum, couscous and spelt all contain gluten and must be avoided. Some newly diagnosed Coeliac individuals are also advised to remove oats from the diet, however gluten-free oats do not cause a problem for most people. This should be discussed on a case by case basis to ensure you are getting the best advice. As a protein gluten is not an essential part of the diet and therefore can be replaced by other foods.
Naturally gluten free foods can be eaten freely, and these include:-
– Most dairy product including milk, cheese and butter
In addition, gluten-free versions of staple food ingredients are available on prescription and this should be discussed with your GP. Prescribable gluten free foods include flour, bread, breakfast cereals, pasta, pizza base mixes, crackers, crispbreads, cakes and biscuits although the product lists tends to change each year so your GP will be able to help with your requirements.
Gluten free products are also available to buy both in stores and online. By law foods can only be labelled as gluten free if they have less than 20 parts per million (ppm) of gluten. For most people this trace amount won’t cause any adverse effects, however for a small minority of people with Coeliac Disease they will have to avoid such products altogether and have a diet completely free of cereals.
The range of gluten free foods has increased extensively in recent years allowing more choice for people with Coeliac Disease. Any concerns over the suitability of a food for a gluten free diet should be discussed with your healthcare professional.
**Where to go for more advice?**
Diagnosis with Coeliac Disease can be daunting but there is good support available both from your local healthcare professional team but also through information organisations such as Coeliac UK (www.coeliac.org.uk). Their website contains a whole range of information on how to manage Coeliac Disease from symptoms to diagnosis, and how to eat gluten free.