Kitty O’Leary is the nurse manager of the endoscopy suite at Mater Private Hospital, Cork. She is also a specialist nurse in intestinal disease.
Here she explains the general facts about gluten and the presenting symptoms seen often in patients with coeliac disease and gluten intolerance:
Gluten is a group of proteins found in grains like wheat, rye and barley of which wheat is by far the most common in Irish people’s diet. For example, gluten is not just in bread, biscuits and cakes but also pasta, beer, pizza and in many manufactured foods such as soups, gravy, dressings, crisps and chocolate.
The two main proteins found in gluten are glutenin and gliadin. Gliadin is responsible for most of the problematic health issues.
When flour is mixed with water gluten proteins create a glue-like consistency which makes dough elastic, and helps bread to rise when baked. Most people tolerate gluten in their diet without any issues.
However, for some, it can cause health conditions like gluten sensitivity, wheat allergy and coeliac disease.
Coeliac disease is the most severe form of gluten intolerance. In Ireland, it is estimated to affect about 1% of the population although it often goes undiagnosed.
It is described as an autoimmune disorder where the immune system attacks the gluten, as well as the lining of the gut which damages the gut wall, and this results in possible nutrient deficiencies, anaemia, severe digestive issues and an increased risk of several other diseases.
Classic symptoms are those related to poor gut absorption and can include diarrhoea, bloating, weight loss, anaemia and in children, growth failure.
Other ways coeliac disease may manifest include a wide range of non-bowel symptoms such as migraines, infertility, fatigue, joint pain, early onset of osteoporosis and depression.
Many people do not have gastrointestinal symptoms, some may have just one symptom and others have no obvious outward symptoms at all.
Initial screening for coeliac disease is a blood test ordered by your family doctor. Blood tests look for the presence of antibodies. If this test is positive, a small intestine biopsy is done in an endoscopy suite like the one in Mater Private Hospital.
A positive biopsy, one that demonstrates damage to the gut lining ‘the villi’, is necessary for a diagnosis of coeliac disease. Strict adherence to a gluten-free diet for life is the only treatment currently available. This means elimination of wheat, rye, barley and foods made with these grains or their derivatives.
Medication is not always required, unless there is an accompanying condition, such as osteoporosis.
Improvement on the gluten-free diet is also clear evidence of the diagnosis. It may take several months or longer for the intestine to heal once gluten has been fully removed from the diet.
When you are on a gluten-free diet, blood tests should eventually come back to normal. This indicates good control of coeliac disease. However, it’s important to point out that this is not a cure, there is no cure, and a return to a diet containing gluten will result in the return of symptoms.
The gluten-free diet is a lifelong commitment and should not be undertaken before being properly diagnosed. Starting the diet without complete testing is not recommended and makes later diagnosis difficult.
Tests to confirm coeliac disease could be negative if a person was on a gluten-free diet for a period of time. For a valid diagnosis to be made, gluten would need to be reintroduced for at least several weeks before testing.
Outcomes are excellent in most cases if a strict gluten-free diet is maintained. The small intestine will steadily heal and start absorbing nutrients normally. You should start to feel better even within days although complete recovery of the intestine will take a little longer.
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