Coeliac disease is an inflammatory condition predominantly involving the proximal small bowel. It is due to autoimmune disorder in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. The most common signs for adults are diarrhea, fatigue and weight loss. Adults may also experience bloating, abdominal pain, nausea, constipation and vomiting.
Medications:
- Tab. Supradyn (multivitamin supplements) one tablet a day.
- Powder Ensure Plus (nutritional supplement) 2 scoops in 100 ml water to be taken once a day.
General advice:
- Gluten free diet
- Foods to avoid – avoid wheat, semolina, rye, barley, malt, beers, lagers, pasta, noodles, breads, pastries, baked goods, sauces, processed and packed food items.
- Common gluten free foods – rice, fruits and vegetables, potatoes, lentils, fish and meat.
Investigations:
- For diagnosis – anti-gliadin antibodies IgG, anti-gliadin antibodies IgA, tissue transglutaminase AB-IgA, endomysial antibodies
- Complete blood count – to check for iron deficiency anaemia.
- Iron studies, vitamin B12 and folic acid levels – to diagnose the cause of anaemia.
- Serum calcium and phosphate – to look for nutritional deficiency due to malabsorption.
- Renal function tests – to rule out renal impairment.
- Liver function tests – to look for liver impairment due to inflammation or fibrosis from gluten rich diet.
- Endoscopy with small bowel biopsy – to look for atrophic villi.
Referral:
Refer to gastroenterologist for endoscopic diagnosis and further treatment.