You Ask , They Answer
Q
: What is coeliac disease and what are the key symptoms ?
A
: Coeliac disease is associated with hypersensitivity to foods that contain a large amount of gluten , such as wheat or barley .
The condition , however , is different from a gluten allergy , which many people have when they mistakenly believe that they have coeliac disease . Symptom-wise , a gluten-related allergy may cause rashes or an asthma attack when wheat is eaten , and it can be diagnosed with an allergy test .
Coeliac disease differs in that it causes specific gastrointestinal symptoms with underlying inflammation in the gut due to a hypersensitive reaction . This renders the villi , which are finger-like structures in the gut , to be shortened , causing mild absorption problems resulting in diarrhoea , loss of weight , and lethargy , all coming together .
There is another spectrum called non-coeliac-related gluten sensitivity , which does not fall fully into the category of coeliac disease . It is not serious enough to cause structural damage to the villi , but the patient will still have some indigestion issues , bloatedness , or abdominal pains after eating food containing gluten .
Q
: How is it diagnosed ?
A
: We take a blood sample and test it for antibodies that are usually present in the bloodstream of people with coeliac disease . The most common tests are for antitissue transglutaminase , IgA anti-endomysial , and anti-gliadin antibodies , the last being the most sensitive .
Once we have confirmed the serology test is positive , then a small bowel biopsy is taken for confirmation . The doctor may also suggest gastroscopy of the duodenum to tell if the patient has a shortening of the villi , which would suggest that it is highly likely to be coeliac disease .
Q
: How is coeliac disease treated ?
A
: The easiest treatment is to just avoid gluten in the diet altogether . Once the patient is taken off food that contains gluten , the symptoms will improve automatically . There is no need for any prescription drugs at all .
The problem is identifying which foods triggers the disease . Even though we say that a gluten-related diet causes coeliac disease , not every single food that contains gluten actually gives rise to the symptoms .
Treatment , therefore , can be tricky . We do not want to restrict the patient from taking all forms of gluten because that might result in some form of malnutrition . The treatment is usually done through trial and error . We start off with the most common foods that contain gluten and gradually expand from there until the patient ’ s weight and absorption improve .
Q
: What complications are associated with it ?
A
: If the coeliac disease is severe enough , it can cause malabsorption issues such as low protein , which may cause the patient to have swelling in the leg and sometimes water retention . Those are very extreme , though . And of course , a patient could end up malnourished , which can be a life-threatening event . It is important to be diagnosed before it reaches that point .
Most of the time , it never reaches an extreme stage because patients will usually get it checked out should the pain become unbearable , and most will do this early .
Dr Alex Leow Hwong Ruey
Dr Alex Leow Hwong Ruey is a consultant gastroenterologist and hepatologist at Pantai Hospital Kuala Lumpur .
14 NOVEMBER 2020 GlobalHealthAsiaPacific . com