Treatment - Coeliac disease

Coeliac disease is usually treated by cutting out foods that contain gluten.

This prevents:

• damage to the intestines (gut)
• diarrhoea
• stomach pain symptoms

If you have coeliac disease, you must give up all sources of gluten for life. If you don't, your symptoms will return. This will cause long-term damage to your health.

Your GP can help you manage your diet. Symptoms should improve within weeks of starting a gluten-free diet. It may take up to 2 years for your digestive system to heal completely.

You should make an appointment with your GP every year for a check-up. At this review, your height and weight gets measured. Your symptoms are also reviewed.

A gluten-free diet

When you're first diagnosed with coeliac disease, you'll get referred to a dietitian. They will make sure you have a balanced diet, containing all the nutrients you need.

You'll no longer be able to eat foods that contain barley, rye or wheat. This includes farina, semolina, durum, cous cous and spelt.

Eating even a small amount of gluten, such as a spoonful of pasta, may cause uncomfortable symptoms. Eating gluten often, increases the risk of osteoporosis and cancer in later life.

Gluten isn't essential to your diet. Many gluten-free alternatives are available. This includes pasta, pizza bases and bread.

Many everyday foods are free from gluten. For example, meat, vegetables, cheese, potatoes and rice. Your GP or dietitian will help you identify which foods are safe to eat and which aren't.

Foods containing gluten

If you have coeliac disease, don't eat:

• bread
• pasta
• cereals
• biscuits or crackers
• cakes and pastries
• pies
• gravies and sauces

You may eat gluten-free versions of these.

It's important to check the labels on food. Many foods, particularly processed foods, contain gluten in additives. For example, malt flavouring and modified food starch.

Gluten may also be in some non-food products. For example, lipstick, postage stamps and some medications.

Cross-contamination can occur if gluten-free foods get prepared with foods containing gluten. Or if they get served with the same utensils.

Gluten-free foods

If you have coeliac disease, you can eat:

• most dairy products, such as cheese, butter and milk
• fruit and vegetables
• meat and fish (although not breaded or battered)
• potatoes
• rice and rice noodles
• gluten-free flours including rice, corn, soy and potato

By law, food labelled as gluten-free cannot contain more than 20mg/kg of gluten.

For most people with coeliac disease, trace amounts of gluten will not cause a problem. But for a small number of people, they will. These people need to have a diet completely free from cereals.

Oats

You may find that eating oats can trigger symptoms. This is because some oats may get contaminated by other grains.

Oats also contain a protein called avenin. This is like gluten. Most people with coeliac disease can safely eat avenin.

A small number of people are sensitive to gluten-free products that do not contain contaminated oats.

Before including oats in your diet, talk to your dietitian. Check the oats are pure and that there's no possibility of contamination.

Avoid eating oats until your diet is working well. When you've no symptoms, reintroduce oats into your diet. If you develop symptoms again, stop eating oats.

Advice on feeding your baby

Do not add gluten into your baby's diet before they're 6 months old. Breast milk is gluten free, as are all infant milk formulas.

If you have coeliac disease, foods containing gluten should get introduced gradually. This needs to be monitored.

Other treatments for coeliac disease

Other treatments include

• vaccinations
• supplements
• medication to treat rashes

Vaccinations

Coeliac disease can cause the spleen to work less well. This makes you more vulnerable to infection.

You may need to have extra vaccinations, including the:

• flu vaccine
• Hib/MenC vaccine
• pneumococcal vaccine

The Hib/MenC vaccine protects against sepsis (blood poisoning). It also protects against pneumonia and meningitis. This is an infection of the lining of the brain,

The pneumococcal vaccine protects against infections caused by the Streptococcus pneumoniae bacterium.

If your spleen is not affected by coeliac disease, you will not need these vaccines.

Supplements

Your GP or dietitian may recommend vitamin and mineral supplements. This may be for the first 6 months after diagnosis.

This helps you to get all the nutrients you need while your digestive system repairs. Supplements also help correct a lack of iron in the blood.

Medication

Dermatitis herpetiformis is an itchy rash caused by gluten intolerance. Cutting out gluten should clear it up.

But it can take a long time for a gluten-free diet to clear the rash. You may get prescribed medication called Dapsone. This is a tablet you take twice a day.

Dapsone can cause side effects such as headaches and depression. Because of this, you'll always get prescribed the lowest-effective dose.

You may need to take the medication for up to 2 years.

Refractory coeliac disease

Refractory coeliac disease is a rare type of coeliac disease. This is where symptoms continue, even after switching to a gluten-free diet. The reasons for this are unclear.

Around 1 in every 140 people develops refractory coeliac disease.

If refractory coeliac disease is suspected, it's likely you'll be referred for tests. This is to make sure your symptoms aren't caused by another condition.

If the diagnosis is confirmed, you'll get a referral to a specialist. Treatment options include steroid medication. These help block the harmful effects of the immune system.