Nursing in Practice March/April 2019 (issue 107) - Page 14

ADVERTISMENT FEATURE Think coeliac: recognising coeliac disease in practice nursing oeliac disease is an autoimmune disease caused by an adverse reaction to gluten. When a coeliac patient consumes food or beverage containing gluten, their body’s immune system attacks its own tissue, resulting in damage to the mucosal lining of the gut and preventing the patient from absorbing nutrients. C As yet, there is no treatment for coeliac disease. Treatment is based on avoiding gluten and adopting a lifelong gluten-free diet. This is largely successful, and enables patients to lead relatively healthy lives. But undiagnosed and untreated coeliac disease increases the risk of numerous potentially grave complications, including irreversible neuropathy. 1 It is estimated that, in the UK, one person in every 100 has coeliac disease. A person’s chances of having it increase to one in 10 if they have a first-degree relative with the disease. But 70% of people with the disease go undiagnosed; thus, almost 500,000 people have coeliac disease but don’t know it. That’s half a million people who live with chronic symptoms, risking long-term damage to their health. In fact, it’s a multi-system autoimmune disorder and the symptoms vary in type and severity, lasting from a few hours to several days. They include: 2 • • • • • • • • • • • • • • persistent diarrhoea and/or constipation nausea, vomiting flatulence abdominal pain or cramps bloating fatigue and excessive tiredness anaemia iron, vitamin B12 or folic acid deficiency liver abnormalities unexplained weight loss frequent, severe mouth ulcers depression and low mood problems with tooth enamel dermatitis herpetiformis – an itchy skin rash characterised by red, raised patches and blistering commonly on the elbows, knees and buttocks • recurrent miscarriage • peripheral neuropathy, ataxia and other neurological symptoms. Symptoms of coeliac disease The similarities between the gastric symptoms of coeliac disease and irritable bowel syndrome can delay accurate diagnosis, and one in four people with coeliac disease have previously been misdiagnosed with and treated for irritable bowel syndrome. 3 Although the main symptoms might suggest it, many people wrongly assume coeliac disease is ‘just’ a gastrointestinal disorder. Coeliac disease remains underdiagnosed, although diagnosis rates have steadily increased over the last 20 years and reached almost one in three people (30%) in 2015. 3 But it takes an average of 13 years for people with the disease to be diagnosed, and such long delays incur costs for the NHS in increased and misdirected use of health services. Patients suffer profound personal costs, too. Living with undiagnosed coeliac disease has a significant adverse effect on people’s health-related quality of life (HRQoL), with HRQoL scores being comparable with those of stroke patients. 4,5 Associated conditions People with coeliac disease are at an increased risk of developing another autoimmune disease. And it is thought that a person’s risk of having a second autoimmune disorder increases with the age at which they are diagnosed with coeliac disease. If someone is diagnosed as coeliac over the age of 20, their chance of developing another autoimmune disorder is as high as 34%. 6 Type 1 diabetes – think coeliac One of the most common associated autoimmune conditions is type 1 diabetes and, according to Diabetes UK, up to 10% of people with coeliac disease also have type 1 diabetes. 7 Symptoms of coeliac disease are often mistakenly attributed to diabetes, and most people get their type 1 diabetes diagnosis first.