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Are you allergic to gluten?

Dubai: Coeliac Disease (CD) is a condition that is difficult to diagnose and results in people suffering indigestion, gas and bloating for prolonged periods.

About one per cent of the UAE population suffers from it and many suffer silently as they are unaware of the condition.

Dubai Health Authority's Rashid Hospital runs a dedicated adult gastroenterology clinic and Dubai Hospital runs a paediatric gastroenterology clinic. As per Dubai Hospital's registry, about 50 children have CD and as per Rashid Hospital's registry, the number of adults with CD is around 25 patients.

Dr Mustafa Sabri, consultant physician and gastroenterologist, digestive diseases unit at Rashid Hospital said the disease does not discriminate.

"The disease affects people of all ages. Once exposed to gluten, it can occur after several weeks or even after years of eating gluten. We had a case in which a five-month-old baby was exposed to solid food containing gluten and it was discovered the baby had CD. Similarly, we have seen many cases where people have eaten gluten for years and the disease only kicks in at a later stage, the period which is non-symptomatic is termed as the free period."

Dr Sabri also added that very often CD has a hereditary origin which means that those who have a close blood relative with the condition have a one in ten chance of developing it.

What is Coeliac Disease?

Coeliac Disease is the inability of the body to digest gluten, a protein found in wheat, rye, barley and processed oats.

Dr Sonia Gupte, General Practitioner at iCare Clinics, Dubai, said: "If you have CD, eating gluten triggers an immune response in your small intestine. Over time, this reaction produces inflammation that damages the small intestine's lining and prevents absorption of some nutrients. Eventually, your brain, nervous system, bones, liver and other organs can be deprived of vital nourishment."

Dr Sabri added: "Patients with other diseases such as irritable bowel syndrome, Down's syndrome and type 1 diabetes are at a higher risk of showing signs of CD."

What causes it?

Normally, the body's immune system is designed to protect it from foreign invaders. When people with CD eat food containing gluten, their immune system forms antibodies to gluten which then attack the intestinal lining. This causes inflammation in the intestines and damages the villi, the hair-like structures on the lining of the small intestine. Nutrients from food are normally absorbed by the villi. If the villi are damaged, the person cannot absorb nutrients properly and ends up malnourished, no matter how much he or she eats.

According to Dr Gupte, in addition to digestive problems, other signs and symptoms of CD include:

Anaemia, usually resulting from iron deficiency

Loss of bone density (osteoporosis) or softening of the bones (osteomalacia)

Itchy, blistery skin rash

Damage to dental enamel

Headaches and fatigue

Nervous system injury, including numbness and tingling in the feet and hands, and possible problems with balance

Joint pain

Reduced functioning of the spleen

Acid reflux and heartburn

How is it diagnosed?

Awareness about the disease is low but one can be diagnosed with blood tests that can detect elevated levels of certain antibodies that indicate an immune reaction to gluten. These tests detect CD even if you have only mild symptoms or none at all.

Dr Batoul Bashir Samarji, paediatric gastroenterologist at Dubai Hospital said that symptoms for the condition varied a lot. "Often, symptoms of Coeliac Disease are confused with other disorders, such as irritable bowel syndrome and lactose intolerance. Patients should undergo the following tests: a blood test to check the antibody level against gluten. The test is known as Tissue Transglutaminase (tTG) Antibody. They should also get an IgA test done to measure the blood level of immunoglobulin A. The doctor will then decide whether to do an upper endoscopy or not."

About a third of people diagnosed with CD experience diarrhoea, and about half have weight loss. Some 20 per cent of have constipation, and 10 per cent are obese.

Dr Samarji added: "It is important for people to understand that wheat allergy is different from CD. To diagnose Coeliac Disease an allergy test is not required and is an incorrect method."

Dr Gupte advises patients who are diagnosed with the condition to opt for a detailed endoscopy examination. "If your blood tests indicate Coeliac Disease your doctor may order an endoscopy to view your small intestine and to take a small tissue sample [biopsy] to analyse for damage to the villi. It's important to be tested for Coeliac Disease before trying a gluten-free diet. Eliminating gluten from your diet may change the results of blood tests so that they appear to be normal," she cautioned.


Once you test positive for the condition, it is important to eliminate all gluten-rich products from your diet such as wheat, rye, barley and oats, giving relief in no time. "Dropping gluten from your diet usually improves the condition within a few days and eventually ends the symptoms of the disease. In most cases, the villi are healed within six months," said Dr Gupte.

But CD patients have to remain on this diet for the rest of their lives as ingesting any gluten at all can damage the intestine and trigger the problem again.

Dr Wafa Ayesh, Director of clinical nutrition at Dubai Health Authority, added that regular breads, bagels, muffins, and many other store-bought baked goods were a complete no-no for Coeliac Disease patients and they had to abstain from gluten for life.

"Ingesting small amounts of gluten can also trigger small intestine damage. Therefore people with Coeliac Disease must learn to check labels to ensure the food is absolutely gluten free. Products such as stabilisers and emulsifiers that are used in processed foods may contain gluten. Oats are often harvested and processed with the same equipment that is used for wheat, and are therefore easily contaminated. However, pure, uncontaminated oats consumed in moderation are generally tolerated by most people with Coeliac Disease. Look for items labelled gluten-free in all products especially for processed foods such as granolas and granola bars."

It's a tough life for Coeliac Disease patients but one that can be managed with due diligence.

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Publication:Gulf News (United Arab Emirates)
Date:May 9, 2015
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