Galway Advertiser 2003/2003_10_16/GA_16102003_E1_020.pdf 

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I M A G I N E I F e a t i n g s o m e t h i n g as simple as a sUce of toast or a piece of cake made you feel really unwell. You might complain of feeling bloated, having diarrhoea or vomiting, being extremely tired and weary. That's how coeliacs feel if they eat any foods containing gluten. Coeliac disease is caused by an interaction between gluten (the protein portion of wheat, rye, barley, and oats) and the small bowel lining in people susceptible to the disease. Professor Joseph Murray, an expert on coeliac disease who is the director of the Coeliac Disease Clinic and Research Programme at the Mayo Clinic in Rochester, explains coeliac disease is a disease of the digestive system. It is caused by damage to the lining of the small intestine which happens when certain genetically predisposed people are exposed to proteins from wheat, rye, barley, oats. Murray - who is originally from Salthill and who gave a public lecture here recently - says the condition occurs more frequently than previously thought. In some European countries and the US, it affects as many as one in 133 people. Most remain undiagnosed. However, more recent figures suggests that in NW Europe, one in 67 people may be affected. While it had once been common in children it now seems to present more in adulthood even in the elderly, he says. S y m p t o m s of coeliac disease may include one or more of the following: severe diarrhoea and/or foul-smelling, loose stools, weight loss, flatulence, and abdominal pain, but it also can cause more subtle symptoms such as chronic fatigue, anaemia, bone problems, joint pains, infertility or foetal loss, dental anomalies, chronic nausea or chronic mouth ulcers. In children and infants, it may present as failure to thrive and/or irritability. I REMAIN HIDDEN Many people with the disease do not know they have it, according to Murray who attended the Bish school and UCG before making his mark in America. He says the condition may remain hidden for ages, only becoming apparent later in life. Even when symptoms occur, the diagnosis may not be made for several years, as coeliac disease may not be suspected. A skin condition with a red blistery rash, known as dermatitis herpetiformis, can also be associated with gluten sensitivity, he says. This is also treated by adopting a gluten free diet, although medication is also sometimes used in addition. "DH presents as a severely itchy rash with blistering skin. Patients with DH develop the same intestinal damage as those with coeliac disease. However, they may or may not have intestinal symptoms. Family members of coeliacs or people with DH have a higher risk of getting coeliac disease. Other patients may be at increased risk if they have Type 1 diabetes, thyroid disorders, Down syndrome, chronic diarrhoea, are of unexplained short stature or suffer from infertility, anaemia or lactose intolerance following a gluten-free diet. How is it diagnosed? Most cases are initially detected from blood tests carried out by GPs, explains Murray whose lecture, which was entitled "Coeliac Disease in the New World', was organised by the western branch of the Coeliac Society of Ireland in partnership with the Department of Public Health in the Western Health Board. He recommends that patients are referred for further tests to confirm the d i a g n o s i s . The treatment involves adopting a gluten-free diet, i e , one which excludes foods made from wheat, barley, rye and oats. "While this may sound easy, it is not and requires education by an expert, support from organisations of people with coeliac disease such as the Coeliac Society of Ireland, and ongoing medical care to ensure that the intestine recovers." Originally, it was believed that people could grow out of the condition. This is no longer the case Murray says as patients will get sick if they reintroduce gluten to their diet. "There are now many excellent products that can be bought or home made that can help make up for the avoidance of bread, pasta and the other typically gluten-containing foods." Most patients who stick to the gluten free diet become well. However, those who don't have a higher than average risk of getting some cancers as well as osteoporosis. He praised the progress made in understanding coeliac disease by the world-renowned coeliac research group in Galway, led by Professors MacCarthy, MacNicholl and Fotrell and Drs Stevens and Mitchell. He says this interest in coeliac disease spawned by these critical Irish contributions has led an interaction between gluten (the protein portion of wheat, rye, barley, and oats) and the small bowel lining in people susceptible to the disease. This results in the body failing to absorb nutrients (protein, fat, carbohydrates, vitamins and minerals) which are necessary for good health. The condition runs in families and, in the past, was thought to only affect children. However, many adults are now being d i a g n o s e d , especially those between the ages of 30 and 45 years. It is also more common for those with type 1 diabetes (insulin dependent diabetes), autoimmune thyroid disease, osteoporosis and epilepsy, to be affected. Also, people from the west of Ireland are more often affected, as are those from the Punjab region of India and Pakistan, the Middle East, and North Africa.

Where to go for further information
T h e C o e l i a c S o c i e t y of Ireland produces a manufacturer's list of gluten free foods each year. For further information please contact: T h e C o e l i a c Society of Ireland, C a r m i c h a e l House, 4 North B r u n s w i c k St, D u b l i n 7 or t e l e p h o n e (01) 8 7 2 1 4 7 1 . The western branch can be contacted through its secretary - Mrs Ellen Feeney, 5 Loyola Park, Galway. E-Mail: coeliachealth@eircom.net Most patients who stick to the gluten free diet become well says Professor Joseph Murray. to a resurgence of interest in the disease in North America where it had been dubbed the Irish Disease and largely ignored. W H A T IS C O E L I A C DISEASE? Coeliac disease is a chronic lifelong condition caused by an inability to digest gluten. The disease results from The Coeliac Society's A G M will take place at the Sacre Coeur Hotel on Thursday October 23 at 8pm. Dr Fiona Stevens, the president of the society is the guest speaker.

The symptoms
INFANTS: Chronic diarrhoea Abdominal distension Poor feeding Poor weight gain Muscle wasting CHILDREN: Chronic diarrhoea or constipation Poor weight gain or growth Poor feeding Anaemia
Ming

ADULTS: Chronic diarrhoea Weight loss Anaemia Weakness Fatigue

TREATMENT The key to treatment is to exclude foods containing gluten from your diet for life. Your doctor may arrange for you to see a dietician for advice. These days most foods are marked if they are gluten free. Many restaurants will be glad to help if you tell them your problem.

CAUSES It seems that some people's genes predispose them to coeliac disease. The result is that sub-sections of the proteins found in wheat and gluten become toxic to the lining of the gut.