NAVIGATION

“My Tummy Upset Won’t Go Away!” Could it be Celiac Disease?

Fiona NEWTON, Family Medicine Physician

Living in China, many of us are familiar with occasional symptoms of diarrhea, gas or abdominal discomfort, which often settle quickly without medical advice or treatment.

If, however, you or a member of your family is experiencing persistent or recurrent abdominal symptoms, please see your doctor for assessment and advice.

Celiac disease is one important cause of ongoing symptoms including abdominal pain, diarrhea, bloating, and excessive wind.

Celiac disease is a condition where the body’s immune system responds abnormally to a protein in some foods called gluten. Gluten is present in wheat, barley, rye and sometimes oats, and in foods prepared from these grains. In a person with celiac disease, eating gluten damages the lining of the small intestine, sometimes leading to abdominal symptoms.

The small intestine is responsible for absorbing the nutrients and vitamins from our food. For this reason, people with celiac disease who eat gluten may also lose weight (or not grow appropriately), feel tired or have a lack of concentration, and be at risk for bone problems. Other health problems including certain itchy skin rashes, and very rarely a particular type of cancer of the small intestine, are associated with untreated celiac disease.

Although celiac disease cannot be cured, avoiding gluten usually stops the damage to the small intestine and the resulting symptoms and health problems. It’s very important that celiac disease is properly diagnosed by a doctor because affected people must completely avoid eating gluten. Even a little bit of gluten is potentially harmful for someone with celiac disease.

A doctor will need to perform a number of tests to diagnose celiac disease. Before having these tests, it is very important to continue eating a normal diet, including foods that contain gluten. Stopping gluten before being tested may lead to falsely negative test results, delaying the diagnosis. Testing includes blood tests for special proteins called antibodies, which are elevated in people with celiac disease who have been eating gluten. Sometimes the doctor may also order a genetic marker blood test to assist in making the diagnosis. If your antibody blood tests are positive, most doctors agree that confirming the diagnosis of suspected celiac disease with a biopsy test of the small intestine is very important. A sample of the lining of the small intestine is collected and examined under the microscope for the typical changes seen in celiac disease. This tiny sample is collected during an upper endoscopy, a test that involves swallowing a thin flexible instrument with a camera. The biopsy is not painful.

Celiac disease can occur in people of any age. The exact cause is unclear but a combination of genetic and environmental factors can trigger the disorder. Celiac disease occurs mainly in those of European ancestry around the world, and also in people from the Americas, the Middle East, North Africa and South Asia. It is uncommon in other parts of Asia (including China) and sub-Saharan Africa. Those with a family history of celiac disease have a higher risk of also having the condition and should consider testing especially if they have symptoms. Celiac disease is also more common in people with other autoimmune disorders including Type 1 diabetes and thyroiditis.

Once diagnosed, the treatment for celiac disease is to completely eliminate gluten from the diet for life. Gluten is found in grains commonly eaten in Western countries including wheat, rye and barley, and in some oats. Gluten is also a hidden ingredient in many prepared foods, sauces (including most soy sauces), medications and supplements. It is present in beer, yeast, and malted drinks. Even gluten exposure from shared chopping boards, toasters, and wok pans is harmful, so when cooking for people with celiac disease it is best to use dedicated gluten-free utensils.

Consulting a dietician or nutritionist is highly recommended for anyone diagnosed with celiac disease. It is important to learn and understand which foods and products contain gluten and which are safe to consume. Maintaining a strictly gluten free diet is challenging, especially when the condition is first diagnosed. Luckily, there remain plenty of nutritious and delicious naturally gluten-free food choices to enjoy. Safe gluten-free food choices include fruits, plain steamed rice and vegetables, eggs, fruit, and meat, poultry, and fish not seasoned with soy or oyster sauce. Gluten-free prepared foods are widely available in Western countries, with some imported products available in China, but it is always advisable to check food labels carefully and consult your dietician for advice.
The internet can be a source of information and support for people with celiac disease and their families. Some reliable sources are:

● Academy of Nutrition and Dietetics (formerly the American Dietetic Association) (www.eatright.org)
● American Celiac Disease Alliance (www.americanceliac.org)
● Celiac Disease Foundation (www.celiac.org)

A website useful for affected people living in or travelling to China is www.gluten-freechina.com. This website contains useful suggestions for accessing gluten –free foods and managing a gluten-free diet while in China.

Although these websites are a great resource, I would always suggest checking dietary guidelines with your dietician as the preferred source of information.

In addition to people with diagnosed celiac disease, many without it report feeling better or healthier when they avoid eating gluten-containing foods. Consulting a doctor for celiac tests and to ensure that all potential causes are explored is important. Testing for celiac disease is only accurate when the person has been consuming gluten for at least several weeks beforehand. If the celiac tests are negative, then limiting gluten to manage the “non-celiac gluten sensitivity” may be helpful to avoid symptoms but complete elimination of gluten may be unnecessary.
Research from Monash University in Australia suggests that the malabsorption of fermentable sugars (known as FODMAPs) may be the problem in some people with irritable bowel syndrome who experience symptoms when eating gluten. Consulting a dietician is beneficial for advice on a diet that may relieve symptoms while still remaining balanced and nutritious.

Resources consulted:

Up to Date
Therapeutic Guidelines

http://www.med.monash.edu/cecs/gastro/fodmap/

Coeliac Australia

www.coeliac.org.au