Coeliac disease


Coeliac disease

Coeliac disease is an autoimmune disease where the immune system reacts abnormally to gluten.

For people with coeliac disease, even small amounts of gluten can damage the lining of the small intestine (bowel),

which prevents the proper absorption of food nutrients

Clinical features


Diarrhea Fatigue

Weight loss

Diarrhea Fatigue Weight loss

Bloating and gas

Abdominal pain


Nausea and vomiting

Joint pain

Dermatitis herpetiformis

Anaemia mouth ulcers


Peripheral neuropathy


Duodenal biopsy showing villous atrophy IgA anti-endomysial antibodies

IgA. Transglutaminase antibodies—High sensitivity and specificity


Investigation for comorbidity 


  • bone mineral density (DEXA) 
  • full blood count 
  • iron, vitamin B12, folic acid 
  • thyroid function tests
  • Calcium
  • Phosphate
  • Vitamin D
  • PTH
  • LFT


Type 1 Diabetes Pernicious anemia

Primary biliary cirrhosis




Autoimmune thyroid disease Downs syndrome



Gluten-free diet – lifelong elimination of all gluten-containing grains (ie. wheat, rye, triticale, barley) from the diet.

Referral to dietician

Treat specific vitamin/ nutritional deficiencies

Pneumococcal vaccination

Referral to gastroenterologist

First-degree relatives should be screened, and if there are several affected family members second-degree relatives

should also be tested.

Screening for thyroid disease, osteoporosis, and other nutrient deficiencies

Lymphoma surveillance


Causes of non-compliance to a gluten-free diet


  • Inadequate education 
  • Lack of cooking skills
  • No  dietician referral
  • Food not prepared by the patient 
  • Frequent travel
  • Frequent travel • Inability to read food labels due to impaired vision
  • Non-English speaking,
  • Frequent dining out
  • Lack of motivation •  Multiple carers
  • Lack of assertiveness


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