Coeliac disease – pronounced ‘see-lee-ac’ rather than how it looks – is one of those ‘why bother’ conditions. It often goes undiagnosed, and we live with it. But it’s also an example of why you can’t be your own doctor and why going for a health screening matters.
Although coeliac disease is often said to present with tummy symptoms including diarrhoea, abdominal pain or distension it can show in more subtle ways. Therefore it often remains undiagnosed and untreated. This is important because untreated coeliac disease can have long-term complications including osteoporosis (thin bones) and increased risk of some cancers of the gut such as lymphoma. In undiagnosed and untreated coeliac disease the risk of these types of cancer is up to 15 percent higher.
Some people’s bodies react badly to gluten (types of proteins that are found in grains like wheat and barley). In this case it’s not an allergy but a permanent intolerance. It leads to a chain reaction in the bowel and intestines as the body goes on red alert, releasing antibodies, causing inflammations and affecting your ability to absorb nutrients, vitamins and minerals properly. Which explains the range of problems it leads to. Everything from o iron to, calcium, Vitamins A, D, E and K are blocked to one extent or another.
Coeliac affects around one in a hundred people in the UK. The public health body NICE believes fewer than a quarter of cases are being spotted and treated – because the symptoms may not be severe, and be the kind of minor grumbles that we become used to over time – when we shouldn’t. It’s a condition that affects slightly more women than men, and is thought to run in families. Around one in ten people whose parents have coeliac disease will also be have the condition. Unfortunately it’s unpredictable as to which relatives and why.
If you’re often having problems with unexplained abdominal problems, close relatives have coeliac, or you’ve already been diagnosed with irritable bowel syndrome, then it’s important to get checked. Current guidelines also recommend offering or considering blood tests for coeliac disease in patients with gynaecological problems such as unexplained miscarriage and difficulties conceiving, those that are tired all the time or those with unexplained iron deficiency or anaemia. It’s also recommended that individuals with auto-immune conditions such as thyroid disease and type 1 diabetes, are also screened.
Like any condition, catching coeliac early is going to save you from health complications and treatments further down the line. Specific testing is needed because of the problems involved with clinical diagnosis. In children, for example, it’s said 43% of cases are free of any symptoms at all. The screening test looks at the level of transglutaminase antibody (tTG) in your blood and this might then be supplemented with evidence from genetic tests and intestinal biopsies to get a clear picture of what’s happening.
There’s no cure as such for coeliac disease. It’s just a case of having a strictly gluten-free diet – no standard breads, cakes, pasta, cous cous etc – which leads to a ‘recovery’ in the intestine, making it able to start performing better. It doesn’t sound too appealing as a diet on the surface, but many people choose a gluten-free diet as a health option, there are plenty of alternatives to grain-based products for this market, and the benefits for health and standard of life in general will make all the more careful choices worthwhile.
Dr Nick Summerton, GP and Medical Director at Bluecrest Health Screening