Coeliac disease

Coeliac disease

About coeliac disease

Coeliac disease is a kind of autoimmune disease. 'Autoimmune' means that the body mistakenly attacks itself when it senses a particular trigger. With coeliac disease, the trigger is a protein called gluten, which is in wheat, rye, barley and oats.

Coeliac disease affects the lining of the small intestine, which is covered in villi. Villi are like tiny fingers that stick out from the intestinal lining. If your child has coeliac disease, eating foods with gluten damages the villi. If the villi are damaged, your child's body can't absorb nutrients properly.

Coeliac disease affects about 1 in 70 Australians. Both children and adults can develop the condition at any age. In children, this can be as young as around six months, once solids containing gluten are introduced.

Causes of coeliac disease

Coeliac disease can run in families. People with coeliac disease inherit genes from one or both parents that make it more likely they might develop it. But not everyone with these genes will go on to develop the condition.

If you, your child's other parent or one of your child's siblings has coeliac disease, your child has a 10% chance of also having the condition.

Environmental factors also play a role. For example, gastroenteritis caused by rotavirus can make it more likely that your child will get coeliac disease, if she has inherited the genes for it. Some types of medication can have the same effect.

If you or someone in your family has coeliac disease, it's a good idea to get your child tested for this condition too.

Signs and symptoms of coeliac disease

Coeliac disease can cause many different signs and symptoms.

If your child has coeliac disease, signs and symptoms might include:

  • nausea and vomiting
  • diarrhoea
  • constipation
  • poor appetite
  • stomach pain
  • mouth ulcers
  • iron deficiency
  • anaemia
  • delayed growth or late puberty
  • weight loss
  • tiredness and irritability.

If coeliac disease isn't diagnosed and treated, it can cause severe long-term health problems, including malnutrition, poor growth, lactose intolerance, osteoporosis, arthritis, liver disease, epilepsy, infertility and cancer.

When to see your doctor about coeliac disease

If you notice any of the symptoms above and they're unexplained or last for more than two weeks, you should take your child to see your GP.

Diagnosing coeliac disease

If you're concerned about your child's symptoms or you think your child might have coeliac disease, getting a proper medical diagnosis is important.

The first step in diagnosing coeliac disease is a blood test. This test measures specific antibodies in your child's blood. If your child has a high level of these antibodies, it might mean that he has coeliac disease. Your GP will then refer you to a gastroenterologist.

The gastroenterologist will do a gastroscopy to confirm that your child has coeliac disease.

A gastroscopy is done under a light anaesthetic and takes about 10 minutes. A flexible tube is passed through your child's mouth and into her small intestine where small tissue samples are taken.

Doctors can look at these samples to see whether the villi are damaged. If they're damaged, it means that your child has coeliac disease.

In some cases, your child might need to do a blood test to see if he has the genes that can lead to coeliac disease. This might happen if the other tests are unclear.

If you think your child has coeliac disease, it's important not to remove foods with gluten from her diet before she has tests to diagnose the condition. Your child needs to be eating foods with gluten so the tests can check how her body is reacting to it.

Treatment of coeliac disease

There's currently no cure for coeliac disease. But it can be managed by following a strict, lifelong, gluten-free diet.

Once your child stops eating gluten, his small intestine can heal and he should start to feel better, usually within a few days or weeks.

Some children with coeliac disease might be low in certain nutrients if damage to their small intestines means they haven't been absorbing nutrients properly. If your child is low on some nutrients, your health professional might recommend that your child takes a supplement for a few weeks or months.

Managing coeliac disease

Even trace amounts of gluten in your child's diet can damage your child's small intestine, although your child mightn't always show signs or symptoms. So sticking to a gluten free diet is very important. Here's how.

Removing foods with gluten from your child's diet
Gluten is found in wheat, rye, barley and oats, so you can start by cutting out foods made with these ingredients. These foods might include:

  • bread
  • cakes
  • biscuits
  • breakfast cereals
  • pizza bases
  • pasta
  • pastry
  • crumbed or battered food.

When your child is first diagnosed, it's important to talk with a dietitian about how to manage a gluten-free diet for your child.

It's a good idea to talk with your child's preschool or school and let them know that your child needs to follow a strict gluten-free diet.

Keeping gluten-free food separate at home
In your home, it's important to keep gluten-free foods separate from gluten-containing foods, so your child with coeliac disease doesn't accidentally eat gluten. Here are some tips:

  • Prepare and store all gluten-free foods away from foods with gluten.
  • Use separate chopping boards and utensils when preparing or cooking gluten-free foods.
  • Clean utensils and appliances that might have gluten-containing foods, even crumbs, on them. A separate toaster for gluten-free breads can be a good idea.

Reading labels on all foods
There can be hidden gluten in many foods, including sauces and soups. There can also be hidden gluten in non-food products too, like medications, supplements and playdough. This means it's very important that both you and your child learn to read labels. Most packaged foods must list ingredients with gluten on the ingredient list.

You can also look out for the crossed grain logo on food packages. This means the food is OK for people with coeliac disease.

Taking care when you eat out
Eating out is an important social activity that your child can still enjoy. But you and your child need to take extra care so that your child doesn't mistakenly eat any foods with gluten.

Many restaurants will flag gluten-free items on their menus. But it's still a good idea to let staff know that your child can eat only food that is strictly-gluten free.

Looking for gluten-free alternatives
You can make or buy alternatives to most foods with wheat, rye, barley and oats.

There are lots of gluten-free cookbooks to help you come up with some new menu ideas. You might like to ask your dietitian to recommend some reliable recipes, cookbooks and websites.

Even if your child has coeliac disease, she can still have a balanced and nutritious diet.