Coeliac Disease Flashcards
What is an allergy?
Body’s immune system strongly reacts
to a particular allergenic protein or
irritant
Applies to all types of immunologically mediated hypersensitivity reaction • Food •Insects • Medications
How to diagnose a food allergy?
Specific IgE antibody testing (skin prick
testing and serum specific IgE)
or
Gold standard:
A double blinded oral food challenge
to confirm the clinical suspicion
What are food intolerances?
Broad term to describe a wide range of adverse
reaction to foods.
Symptoms after eating some foods; • Stomach pain • Bloating /flatulence • Diarrhoea • Irritable bowel syndrome(IBS) • Rashes • Hives(Urticaria) • Recurrent mouth ulcers or headache
How to manage a food intolerances?
Temporary elimination diet
• If symptoms improve –challenge under controlled
conditions to identify triggers that many be
avoided in future
What is Coeliac Disease?
Coeliac disease is a common autoimmune enteropathy triggered by the ingestion of gluten.
Involves Permanent intolerance to gluten proteins
• wheat, barley, spelt, rye, oats
What does gluten do?
• Chronic inflammation of small
intestinal mucosa
• Atrophy of the villi
• Reduces absorptive capacity of the
small intestine
What are the Gastro symptoms of Coeliac Disease?
- Abdominal bloating
- Abdominal pain
- Flatulence
- Diarrhoea
- Vomiting
- Constipation
What are the non gut related symptoms of Coeliac Disease?
- Anaemia (iron, vitamin B12, folic acid)
- Anorexia
- Weight loss
- Short stature/growth failure
- Irritability (children)
- Alopecia
- Osteoporosis and tooth enamel defects
- Recurrent aphthous stomatitis
- Amenorrhoea
- Fertility disorders
- Abnormal liver biochemistry
- Chronic fatigue
How is Coeliac Disease diagnosed?
•Clinical Hx •Serology •Small bowel biopsy -Histology •Improvement of symptoms and antibody response to a gluten free diet
How do you manage Coeliac Disease?
- Life long gluten free diet
- All traces of gluten are avoided
- Make sure to educate about disease and;
- Cross contamination
- Label reading
- Eating out
- Catering
What are some examples of Possible PESS Statements?
Inappropriate protein (gluten) related to Coeliac Disease diagnosis, Nutrition knowledge deficit, Flattened intestinal villi as evidenced by Positive anti-tTg test, Weight loss (x), Bloating and diarrhoea, Diet hx revealing gluten x and contamination.
What is the “Food & Nutrient Delivery” Intervention plan for Patients with Coeliac Disease?
Food & Nutrient Delivery:
Identify gluten containing foods for alternatives/ swap types of food
What is the” Nutrition Education” Intervention plan for Patients with Coeliac Disease?
o Assisted pt acquiring knowledge Coeliac Disease (NEMO resource)
o Coeliac Association resources for foods containing gluten
o Education sources of gluten/ non-gluten) / recipes/ supplier resources
o Strict lifelong elimination of gluten – if followed, improvement will be within 2 weeks often.
o Wheat free is not the same of gluten free; products may contain rye and barley
o Wheat starch is acceptable because gliadin/gluten has been removed
o Possible contamination in oats in Australia – best to avoid
o Label reading
o Be aware of hidden products (cosmetics, food types, herbs)
What is the” Nutrition Counselling” Intervention plan for Patients with Coeliac Disease?
o Goal Setting - Smart Goal
o Use work, university and social aspect for motivation
o Include family members if relevant
o Educate family members/school/ friends to be aware
o Negotiate dinners/ counselling to improve nutrition intake
What is the” Co-ordination of Care” Intervention plan for Patients with Coeliac Disease?
Refer to GP for blood test:
Monitor deficiency of major vitamins/mineral potential: Fat Soluble vitamins, Calcium. Iron, B12, Mg2+, Monitoring through Bristol stool chart.
Bone mineral density (BMD) scan
