COELIAC DISEASE: Dr. Kim Faulkner-Hogg Dietitian Allergy Unit, RPAH, Sydney [email protected] (02) 9515 3323 WHAT IS COELIAC DISEASE? Gluten Ingestion Inflamed Small Intestinal Mucosa Villous Atrophy Gluten-Free Diet Restoration of Health PREVALENCE of COELIAC DISEASE • Historically in Caucasians 1:300 - 1:2000 • Ireland and Scandinavia 1: 100 • Algeria in Africa 1:18 • Australian prevalence 1:2501 • Worldwide Screening Diagnosis 1:266 2 • Worldwide Clinical Diagnosis 1:33452 1. Hovell et al, 2001 2. Fasano & Catasi, 2001 CLASSIC SYMPTOMS • Malabsorption • Failure to thrive • Nausea • Vomiting • Weight loss • Steatorrhoea • Muscle wasting • Weakness • Diarrhoea • Bruising • Abdominal cramp • Bloating • Flatus MINOR NON-SPECIFIC COMPLAINTS • Headaches • Dizziness • Constipation • Skin rashes • Tiredness • Recurrent mouth ulcers OTHER SIGNS • unexplained iron or folate deficiency • delayed menarche • sub-optimal school performance • apparent food intolerances • enamel defects of permanent teeth • infertility in either gender • recurrent miscarriages • general malaise Malabsorption of • lipid • carbohydrate • protein • iron • calcium • magnesium • vitamins (especially fat soluble ones) 10-20% of first degree relatives have coeliac disease RISKS OF UNTREATED DISEASE • Sub-optimal nutrient • Infertility absorption – of protein, fat, CHO, iron, • Neurological disorders calcium, magnesium, zinc and vitamins – Ataxia – Epilepsy • Low nutritional status – Early Onset Dementia – Anaemia • Liver disorders – Reduced bone mineral density • Peripheral neuropathy • Increased risk of malignancy Diagnosis of Coeliac Disease 1. Initially a blood screening test looking for coeliac related antibodies 2. Secondly a small bowel biopsy to look for damage to the small bowel 3. Repeat biopsy generally 6 months later to show recovery of the small bowel DIAGNOSIS The European Society for Paediatric Gastroenterology and Nutrition (ESPGAN) • First biopsy: • Must show small bowel mucosal atrophy on a gluten containing diet • Second biopsy: • Small bowel should show improvement or normalization while on a GFD. • The need for gluten challenge and 3rd biopsy is assessed individually.