Coeliac disease (CD) is an autoimmune condition triggered by eating gluten, a protein found in wheat, barley and rye. It affects 1 person in every 100. For people with CD, eating gluten causes the body’s immune system to attack its own healthy body tissues, causing damage to the lining of the small intestine. Villa, the finger like projections lining the gut become inflamed and then flattened, limiting digestion and absorption of nutrients.
What are the symptoms?
The symptoms vary from child to child and differ in their severity, with some children experiencing very minor symptoms or no symptoms at all. Others may experience the classic symptoms of growth faltering, abdominal pain and diarrhoea with malabsorption of nutrients. A secondary or transient lactose intolerance can result from the damaged gut lining, and exclusion of lactose from the diet may required until the gut begins to heal. Reintroduction of lactose back into the diet can usually begin following a 6 week exclusion.
Starting a gluten-free diet
It is important not to start the gluten free diet until after the tests have been carried out. The usual coeliac screening tests are reliant on the presence of gluten in the diet to show a positive result. Once the diagnosis is confirmed, all children should see a Registered Dietitian with expertise in treating CD in children and start a gluten free diet. The gluten free diet is for life, and the only treatment for coeliac disease. The gut will begin to heal within a few weeks, although for some it can take longer for the gut to fully heal. Children should avoid eating oats at diagnosis, and may trial them once all their test result have normalised. Many adults and children can tolerate oats in their diet, but as there is no specific test for oats, they are better avoided in children until the gut has time to heal fully.
Eating a gluten free diet
Gluten is found in wheat, barley and rye, and some people are sensitive to the oats. There are many naturally gluten-free foods such as meat, poultry, fish, cheese, milk, fruit, potatoes, vegetables, pulses, rice and corn. Limited amounts of specialised gluten-free staple foods including flour, bread and pasta are available on prescription for children with a positive diagnosis under guidance by a Registered Dietitian. Foods containing gluten are found bread, biscuits, pasta and cakes but also in sauces, ready meals and sausages. For more information about a gluten free diet see Coeliac UK, a charity supporting people with all aspects of the condition.