Q. I suppose nearly every mother has heard of coeliac disease and hopes her child will not contract it. What is involved?
A. This is a disease of the small bowel characterised by frequent loose bowel actions, general nutritional debility, failure to grow, irritability and a pot-belly in children. In adults, the picture may be similar but anaemia may also develop. The first part of the small bowel, the jejunum, is affected. The villi, the microscopic finger-like tentacles that absorb the food, are adversely affected by the gliadin fraction of gluten. (Gluten is the protein of the wheat grain.) Their normal function is destroyed and food absorption is disrupted. This accounts for the wasting and general physical decline.
There is often a familial tendency. It affects one in 4,000. It can occur in any age but is more common in children or infants when they switch from milk to grain foods. Although it may occur in adults there is often a vague history of mild ill health and stunting of growth in childhood or a sore tongue. Adults may show an anaemia due to a deficiency of Vitamin B12, iron and folic acid absorption.
Q. How is it diagnosed and treated?
An accurate diagnosis may be established by small bowel biopsy and an improvement when gluten is removed from the diet. Once the diagnosis has been accurately made the beneficial results of treatment are often dramatic. The patient is placed on a gluten-free diet. Wheat, barley, rye and sometimes oat-containing products are excluded, and this must continue for life. The aid of a skilled dietitian is essential.
Symptoms may start to disappear within a few days. However, it may take months, or up to a full year, for the full benefits to occur. Loose stools may persist for many months. But a general feeling of well-being, improved appetite, weight gain and loss of irritability is usually rapid. Between 80 and 90 per cent of patients quickly improve on this relatively simple routine. Coeliac Societies exist in most countries and membership for coeliac patients is an excellent idea. Recipes for making gluten-free products are made available and helpful suggestions offered.
Parents soon become proficient at making gluten-free bread and other food items. Often this may be made on a weekly (or less frequent) basis and deep frozen until needed. Once the routine has been commenced it is usually no great domestic burden and most parents are happy to have discovered a way of helping their child. The burden of the extra work is far outweighed by the stress and anxiety of a perpetually ill, undernourished child. Symptoms which indicate coeliac disease should never be neglected. Often referral to a paediatrician is necessary, for adequate investigation is usually a specialist procedure.
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