Home Forums Other Specialities Gastroenterology COELIAC DISEASE-PRACTICE POINTS

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    Anonymous
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    Coeliac disease

    Multiple screening studies have shown that the prevalence of coeliac disease in the UK is 1%,with 6-8 going undetected for every one diagnosed.
    Because the diagnostic yield for coeliac disease in patients thought to have possible irritable bowel syndrome is around 5%, testing for coeliac disease in suspected IBS has been included in UKguidelines.

    Several international groups having documented an increase in incident cases of coeliac disease, as well as other autoimmune conditions, such as type 1 diabetes, which, as does autoimmune thyroid disease, shares many of the genetic traits of coeliac disease.

    Everyone with positive serology for coeliac disease should be referred for biopsy, under the care of a gastroenterologist.

    Untreated coeliac disease can be associated with increased morbidity and mortality, and may have a negative impact on an undetected individual’s quality of life. Early institution of a gluten-free diet may avoid these complications.

    First-degree relatives of those with coeliac disease have a one in 10 chance of having coeliac disease, and it is recommended that relatives be tested when the index case is diagnosed, and repeat testing may be warranted if new symptoms develop.

    Current Diabetes UK guidelines also recommend testing for coeliac disease of patients with newly diagnosed type 1 diabetes mellitus. Testing is recommended at diagnosis and if new symptoms develop.

    There is a well-documented risk between coeliac disease and small bowel lymphoma and adenocarcinoma, but risks of malignancy are low, and patients may even be at a reduced risk of other common diseases such as cardiovascular disease.4

    Recent paediatric guidelines for the assessment of coeliac disease demonstrate that the prevalence of children with isolated stunted growth is in the region of 10-40%: failure to thrive is an absolute indication to test for coeliac disease in children.

    Coeliac disease is a lifelong condition with potentially serious long-term consequences, such as osteoporosis, subfertility, growth failure, anaemia and malignancy.
    Although food intolerance (including wheat and gluten) may result in similar symptoms, which can be distressing, it should not result in these long-term problems.

    Patients with coeliac disease are at increased risk of reduced bone mineral density and osteoporosis and are at higher risk of fracture. There is good evidence that maintaining a strict gluten-free diet can result in a slowing or reversal of bone loss.

    Some patients may not be asking for gluten-free products because of personal preference. There are national prescribing guidelines recommending the monthly allowance of units that should be available to an individual based on age, gender and energy requirements.

    Patients with coeliac disease should undergo an annual review to assess adherence.
    Those with persistent symptoms, persistently elevated serology or those suspected not to be adhering to a gluten-free diet should be referred to a gastroenterologist and a dietician for further investigation and advice.

    G Mohan.

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