Introduction
Coeliac Disease is a condition where the lining of the small bowel is damaged by a protein in food called gluten.
Coeliac disease affects about 1 in 70 Australians. Around 80% of these people are undiagnosed. This means many people with coeliac disease do not know they have it.
Coeliac disease can develop at any age after foods and medications that contain gluten are introduced to their diet.
Gluten is found in grains such as:
- wheat and wheat derivatives, like durum, spelt, semolina
- barley
- triticale
- malt
- rye.
Proteins that are similar to gluten can also be found in oats and may also cause coeliac disease.
Coeliac disease is a genetic condition, meaning it can be passed down in families. Parents, siblings, and children of someone with coeliac disease will have a 10% chance of also having the disease.
Coeliac disease can also develop alongside other conditions like:
- type 1 diabetes
- thyroid disease
- Down syndrome.
Signs and symptoms
When a child with coeliac disease eats gluten, it can lead to damage to the villi. Villi are tiny fingers covering the inside of the small bowel that absorb nutrients from food.
The inflammation caused by gluten flattens the villi. This leads to poor nutrient absorption, which can make your child very sick.
Symptoms of coeliac disease can include:
- stomach ache
- bloating
- vomiting
- constipation - hard poos that are difficult to pass
- diarrhoea - loose poos that are difficult to control
- irritability
- poor weight gain, weight loss and slow growth
- low levels of essential vitamins and minerals
- anaemia – a condition caused by low iron levels which can cause children to become pale and unusually tired
- osteoporosis - brittle bones from low calcium and vitamin D
- mouth ulcers
- unexplained fever.
Some children with coeliac disease may have very few or no symptoms.
Diagnosis
Blood test screening
Blood tests are done to check for coeliac disease if your child has symptoms or other health issues like:
- slow growth
- a family history of coeliac disease
- medical conditions like diabetes
- genetic conditions like Down syndrome.
The blood tests for coeliac disease look for high levels of specific antibodies. Antibodies are proteins made by the body to help fight disease.
Your child will also have a total immunoglobulin A (IgA) blood test to help explain the antibody test results.
Biopsy of the small bowel
A biopsy of the small bowel is done to confirm the diagnosis of coeliac disease.
A biopsy is a surgical procedure that is done under a general anaesthetic. This means your child will be asleep.
This procedure passes an endoscope through the mouth, stomach, and small bowel.
An endoscope is a long, flexible tube with a camera and tiny surgical tools attached to it.
The camera is used to see inside the body and make sure it is in the right place. The tiny tools are used to take a sample of tissue from the small bowel.
The sample of tissue from the small bowel is tested in a lab to see if there has been any inflammation or damage caused by coeliac disease.
Keeping your child on their regular diet while they are being diagnosed is very important. Your child's doctor will let you know if or when it is time to change your child's diet.
Treatment
Coeliac disease is treated by removing gluten from your child's diet, along with any medications given by their doctor.
Treatment will settle the inflammation in the small bowel, allowing it to heal.
Gluten-free diet
Once your child is diagnosed with coeliac disease, they will need to remove gluten from their diet for life. This is called a gluten-free diet.
Your child will need to remove all gluten from their diet, even small amounts. Even a tiny amount of gluten can cause further damage to the gut, even if there are no symptoms.
Common foods that can be replaced with gluten-free options include:
- breads
- biscuits
- cereals
- sauces
- pasta and noodles.
Your child will have follow-up appointments with their doctor to check that:
- they are growing well
- they are following a gluten-free diet
- the antibody levels have returned to normal.
It may take time for the antibody levels to return to normal and for your child to start to feel better.
Your child may also see a dietician who will help you and your family:
- learn about gluten-free diets
- learn how to spot hidden gluten in foods
- make sure your child is eating well
- support your child in managing their diet independently as they get older.
A gluten-free diet can sometimes result in lower levels of essential vitamins and minerals in children. Your child's treatment team may suggest supplements to help with this.
Low-lactose diet
Your child's treatment team may also suggest a low-lactose diet for a short period.
Lactose is a sugar found in dairy products. Lactose does not cause damage to the small bowel. Damage to the small bowel caused by coeliac disease can affect the way the body digests lactose.
A low-lactose diet can help the small bowel to heal after starting a gluten-free diet.
Resources and more information
