Coeliac Disease

is a autoimmune disorder that permanently affects the digestive system and is triggered in genetically susceptible individuals by the ingestion of gluten.

When a person with celiac disease (CD) consumes foods that contain gluten, it causes an immunological reaction in the small intestine, which damages the interior of the small intestine known as the villi. Villi are finger-like projections that line the interior of the small intestine and once they become inflamed and essentially flattened from the reaction with gluten, malabsorption of the nutrients needed for good health occurs.

Coeliac Pathophysiology

Diagnosis of CD

Current serological tests for CD are highly sensitive and specific. IgA-TtG and IgA-EMA are recognised as the most sensitive and specific serological tests for CD diagnosis. To obtain accurate test results it is imperative that serological tests be performed prior to eliminating gluten from the diet.

A positive blood test indicates the need for a biopsy. The gold standard for diagnosing CD is the small intestinal biopsy where cells or tissues are removed for examination of villous atrophy (damage of the villi in the small intestine). It is important that biopsies be taken prior to eliminating gluten from the diet as histological findings can begin to normalize upon initiation of a gluten free diet.

Dietary management of CD

Once diagnosed with CD the treatment is a gluten-free (GF) diet, which must be adhered to for life, and which involves the removal of wheat, rye, barley, oats and derivatives of these cereals from the diet.

As this is a life long change it is important that you are best equiped to navigate moving forward. Working closely with a dietitian to ensure nutritional intake adequacy despite food restrictions is key. A Gastrointestinal Dietitian can support you on your journey through tailored education and provision of specialised resources that can include:

Sample meal guides & gluten free recipes, books
Food list - Foods to include (gluten free) and foods to avoid (contain gluten)
Gluten free & label reading education
Healthy gluten free eating advice & nutritional adequacy
Managing gluten free at school/ work
Gluten free shopping strategies
Getting enough fibre to regulate bowels
Strategies for cooking gluten free

Post Diagnosis

Coeliac disease is a serious condition that requires a proper medical diagnosis and adequate medical follow up and dietary education.

Bone Density Scan: All adults diagnosed with coeliac disease should have a bone density scan to check for osteopenia or osteoporosis.
Tests for Associated Conditions
- Electrolytes e.g. sodium and potassium which measure kidney function.
- Liver function tests.
- Thyroid function - autoimmune thyroid disease (Graves disease or Hasihimotos) can beassociated with coeliac disease.
- Fasting blood glucose to check for autoimmune diabetes (type 1 diabetes or Latent Autoimmune Diabetes (LADA)).
Deficiencies: Deficiencies can include: iron, calcium, phosphate, vitamin D, zinc, vitamin B12, folate, magnesium.
Compliance: Screening blood tests (Coeliac serology) and Small bowel biopsy post diagnosis to confirm healing.
Family Screening: Family members should be screened for active coeliac disease.

Gastrointestinal System - Coeliac Disease Background. 2018. PEN
Coeliac Disease and Nutrition. (2014). Advanced Nutrition and Dietetics in gastroenterology.
Mendoza, N. Celiac disease: an overview of the diagnosis, treatment and management. Nutr Bulletin. 2005 [cited 2013 Nov 1];30(3):231.

Ongoing symptoms despite strict long term Gluten Free diet? other considerations & investigations

Gluten contamination
Lactose intolerance
FODMAPs
SIBO
Microscopic colitis
Exocrine pancreatic insuffieciency
Giardiasis
Hyperthyroidism

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