Why its REALLY important to be correctly diagnosed!!

While the explosion of gluten free food on supermarket shelves and cafe menus highlights an increasing awareness of CD, three is another side to this story. It's increasingly common for people to attribute their gastrointestinal symptoms to wheat and self-diagnose CD, while many TRUE Coeliacs remain undiagnosed.
"Alot of people think they are gluten sensitive when they are not" says Dr Ian Brown, Anatomical Pathologist at Envoi Pathology and they Royal Brisbane & Women's Hospital. "They often have IBS or other reasons for their symptoms, but they stop eating wheat products and probably do feel better becasue of it. But that DOESN'T  mean they have Coeliac Disease which is an autoimmune disorder that affects about 1% of the population."
There is more to diagnosing CD than just feeling better from avoiding wheat products. While there may be obvious symptoms such as feelings of discomfort, diarrhoea, abdominal pain, bloating and (eventually) weight loss, there are also symptoms that require medical expertise to link them to CD.
"There may be neurological symptoms, osteoporosis at a young age, dermatitis, anaemia or iron deficiency", explains Dr Brown. "In fact, more people are now being picked up with ATYPICAL presentations and unusual manifestations than just gastrointestinal symptoms. This is why it is important to get a definitive diagnosis, and that happens through pathology tests."
Dr Brown says the gold standard test is a Small bowel biopsy, while serology (blood) tests are also very accurate.
"In some cases we also need to look for a particular genetic marker" says Dr Brown. "But, most people have the serology and biopsy to confirm if the have coeliac disease, and about 20% of new diagnoses are in people over 60 years of age."
This brings us to the question of whether people ar BORN with CD or simply develop a reaction to gluten at some point down the track. The answer is BOTH, and once you do develop CD its there for life.

"You need to have a genetic predisposition to CD and then an environmental influence to trigger it" explains Dr Brown. "This influence is not clearly defined at present, but it might be a bowel infection which lets gluten into part of the bowel it would not normally get into. This then sets up the immune reaction"

This immune reaction takes place in the Small intestine because gluten contains big proteins that are not broken down in the stomach. It is also rich in particular amino acid with an elector specific charge that binds very tightly to a surface receptor of special cells in the small intestine in people with a genetic predisposition to CD. This sets off an inflammatory reaction as the body reacts to this receptor-bound protein and calls in other cells to help with this process. This battle rages every time gluten is eaten.

Based on this reaction, avoiding gluten is obviously an essential part of controlling CD and a life-long dietary commitment. It therefore makes sense to have the required pathology tests to absolutely rule it in or out before such a commitment is made.


Extract from PathWay the Royal College of Pathologists of Australasia