Coeliac Screening

Colon Hydrathereapy

Coeliac screening: About 1% of Irish people have coeliac disease but many cases are only diagnosed after many years of treatment of other conditions that are actually symptoms of coeliac disease. Only about half of coeliacs show classical signs of being gaunt, underweight and malnourished in addition to gastrointestinal symptoms. Some don't even have gastrointestinal symptoms. Coeliac is more common amongst people suffering from anaemia or infertility. This test screens for the characteristic anti-tissue transglutaminase IgG and IgA antibodies.While 20% of Irish people carry the predisposing HLA gene marker, other factors are necessary in order to develop coeliac disease - not just gluten. Our modern Western diet is undoubtedly a major contributor.

What is Coeliac Disease?

Coeliac Disease (CD) is an autoimmune disorder that damages the small intestine and interferes with the absorption of essential nutrients from food. People who have CD cannot tolerate gluten - a protein found in wheat, rye, and barley. Gluten may also be found in everyday products such as medicines, vitamins and lip balms.

When people with CD eat foods containing gluten (or use products containing gluten), this triggers a severe autoimmune response which damages the tiny, finger-like protrusions (villi) lining the small intestine. Villi enable nutrients to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, a person rapidly becomes malnourished, regardless of how much food is consumed.

CD affects approximately 1 in 100 people and can occur at any age. Under-diagnosis, however, is a major factor. According to Coeliac UK, only 10-15% of sufferers are clinically diagnosed. If a first degree family member (mother, father, sister or brother) has the condition, then the chance of developing the disease increases to 1 in 10.

Treatment

Coeliac disease is not curable. It is a permanent, life-long condition and there is no medication available to treat the disease. However, damage to the small intestine is reversible, so patients should follow a gluten-free diet to eliminate all foods derived from wheat, rye or barley (and oats if contaminated with wheat). If a gluten-free diet is strictly adhered to, the intestinal villi can recover and patients should experience an improvement in symptoms.

Symptoms of Coeliac disease:

CD is associated with a wide variety of symptoms:

  • Weight loss
  • Tiredness
  • Vomiting
  • Headaches
  • Lethargy
  • Breathlessness
  • Abdominal discomfort
  • Anaemia
  • Mouth ulcers
  • Diarrhoea

Because of the broad range of symptoms, CD is difficult to diagnose. Left undiagnosed, CD can increase susceptibility to life-threatening conditions such as osteoporosis, central nervous system diseases, internal haemorrhages and certain cancers (lymphomas), so early detection is vital.

While there is no cure for CD, strict adherence to a gluten-free diet can reverse the damage caused to the intestinal villi, often resulting in an improvement in symptoms.

Diagnosis:

The new blood antibody test is compelling evidence of CD. A follow-up intestinal biopsy may be performed for final confirmation.

Details of the new Coeliac Screen Test:

A great advantage of the new test for Coeliac Disease is that only a few pinprick drops of blood are required to do the analysis.

How does the test work?

The Coeliac Screen (tTG) test is an ELISA-based method for the detection of circulating IgA and IgG antibodies raised against tissue Transglutaminase (tTG):

tTG IgA

Studies have shown that IgA antibodies to tTG - an enzyme present in the connective tissue of the gut - are also strongly associated with the presence of CD. tTG IgA antibodies are highly sensitive (95% -100%) and specific (90%-97%) for CD.

tTG IgG

Patients with CD can exhibit IgA-deficiency. In such cases, the tTG IgA test will produce a negative result. A tTG IgG test is then recommended to prevent false negative results being obtained (NICE clinical guideline 86).

Testing is simple and involves screening a blood sample for tissue Transglutaminase antibodies. A positive result is compelling evidence of Coeliac Disease.

Coeliac Screen Test

1. Your practitioner will prick the finger with the safety lancet provided.

2. Capillary action will draw the required volume of blood into the micropipette.

3. Your practitioner will drop the blood into the round window chamber on the test kit.

4. Your practitioner will read the colour change results after 10 minutes.

Sensitivity Specificity
94% 97%
 

FAQs

A gluten-free diet is essential for people who have coeliac disease or dermatitis herpetiformis (a gluten induced skin sensitivity). However, according to recent research, there are many pre-coeliacs or gluten-intolerant/sensitive individuals that benefit from a gluten-free diet.

What is gluten?

Gluten is a mixture of proteins found in wheat, rye and barley (and to a lesser extent, oats). A gluten-free diet is the complete avoidance of foods containing these grains.

It is important to note, that a gluten-free diet is not the same as a wheat-free diet, and some gluten-free foods are not wheat free.

Is it possible to be gluten intolerant without coeliac disease?

Many people find that they have a sensitivity to gluten, but do not test positive for coeliac disease. A food intolerance IgG test will confirm the presence of antibodies to gluten, and hence the likelihood of intolerance. If intolerant to gluten, then a gluten-free diet needs to be followed as for coeliac disease, although some people find that they may tolerate oats if they have not been contaminated with wheat. With an intolerance, gluten maybe introduced successfully back in to the diet after a few months of elimination, whereas this is not the case with coeliac disease.

How does a gluten-free diet affect vegetarians or vegans?

Vegetarians and vegans should be aware that some gluten-free flours are low in protein, due to the removal of gluten, however, specially manufactured, prescribed gluten-free flours often have milk protein added. Please check ingredients labels carefully.
Other proteins suitable for vegetarians/ vegans can be obtained from nuts & seeds, pulses, non-gluten containing cereals, soya products, milk, cheese and free range eggs.

The Vegetarian Society can provide further information. See www.vegsoc.org

Where can gluten-free foods be bought?

A wide range of specially manufactured gluten-free foods such as, bread, bread mix, pasta, biscuits, cakes, crisp bread and flour can be found in most supermarkets (such as Tesco, Dunnes Stores, Super Value, Lidl, Aldi), chemists (Boots, Lloyds) and health food shops (such as Holland and Barratt). Some manufacturers use the gluten-free symbol on their label.

If I've been avoiding gluten will this affect the test?

The NICE guidelines from May 2009 state that gluten should be included in the diet in at least one meal daily for a minimum of 6 weeks before testing, which is what we also advise. However, we also recommend that if you start having severe symptoms when reintroducing gluten to stop.  However it is possible that symptoms may be due to being intolerant to other proteins in wheat in which case you may like to experiment with foods including rye or barley in your diet.   If symptoms subside this will ensure that you are still eating gluten and so are able to perform the test.