Coeliac Disease (CD) is a chronic autoimmune disease triggered by the ingestion of gluten which results in damage to the small intestine. If Coeliac Disease is left untreated it can lead to serious health conditions such as iron deficiency, early onset osteoporosis and infertility. Coeliac Disease can develop at any age and has a strong genetic component meaning that it runs in families.

Symptoms of CD

In children:

Abdominal bloating and pain, chronic diarrhea, vomiting, constipation, pale or fatty stools, iron deficiency anaemia, weight loss, fatigue, irritability and behavioural issues, delayed growth and puberty, attention deficit hyperactivity disorder (ADHD).

In adults:

Unexplained iron deficiency anaemia, fatigue, bone or joint pain, osteoporosis, liver and biliary tract disorders, depression or anxiety, peripheral neuropathy (tingling or numbness in the hands and feet), missed menstrual periods, infertility or miscarriage, or dermatitis herpetiformis (itchy skin rash).

Coeliac Disease can also be silent also known as asymptomatic Coeliac Disease. Where patients do not experience the symptoms mentioned above but still experience damage to the small intestine.

If you have an immediate family member with Coeliac Disease you should be screened, since there is a 1 in 10 chance of developing Coeliac Disease.

Currently the only treatment is a strict gluten free diet!

This means avoiding the following foods containing gluten:

• Wheat

• Rye

• Barley
• 
  
• Oats (Australia)

• Triticale

An IBS diagnosis is made using the Rome IV criteria:

"Recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with two or more of the following criteria:

Related to defecation

Associated with a change in frequency of stool

Associated with a change in form (appearance) of stool." (1)

An IBS diagnosis is made by a doctor. It is advised that diagnosis is followed up by an initial consultation with a Dietitian trained in FODMAP and IBS, to ensure the most evidence-based nutrition care is provided.

Diagnosis

IBS can only be diagnosed by a doctor, assessing the following criteria:

Abdominal pain associated with at least 2 of these symptoms for at least 1 day each week in the past 3 months.

- Pain related to bowel movements.

- A change in defecation frequency

- Change of the consistency or appearance of faeces

Symptoms must be present for 6 months before a diagnosis of IBS is made.

A breath test may be used to determine if a patient has IBS. The test measures the amount of hydrogen and methane in the breath which correlates to gases produced by gut bacteria. Abnormal amount of these gases may be indicative of lactose intolerance, small intestine bacterial overgrowth (SIBO), or another infection.

Treatment

Dietary change may/may not be enough to improve symptoms. Dietary modification should be undertaken with the help of a health professional such as an IBS dietitian. Sticking to a low FODMAP diet is often recommended particularly in the early stages of diagnosis.

What are FODMAPs?

FODMAP stands for =Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These are sugars that are poorly absorbed in the intestine and can be a trigger of IBS symptoms. Therefore, avoiding these sugars may alleviate symptoms.

They can be found in the following foods:

-Gas producing foods: Onion, garlic, cabbage, Brussel sprouts, dried beans, lentils and cauliflower, apples, pears, mango.

- Lactose containing foods: Milk, some yoghurt, cream, ice-cream.

- Artificial sweeteners in foods and drinks: Sorbitol and mannitol

- Some alcoholic beverages and drinks: Rum, some wines, mixed drinks with fruit juice or added fructose.

Probiotics may have a role in improving symptoms, but the research on the specific strain and dose to provide the greatest benefit is still unknown.

Some behavioural and psychological therapies may improve symptoms of IBS, particularly if triggers are stress or anxiety.

IBD is a broad category for chronic inflammation of the digestive tract. Conditions include Crohn’s Disease (CD) and Ulcerative Colitis (UC).

The exact cause of IBD remains unknown but it is known to be a result of a fault immune system. In IBD the immune system reacts inappropriately to environmental triggers like food which cause gastrointestinal inflammation. There is evidence to suggest that IBD has a genetic component.  

Symptoms of IBD

• Persistent diarrhea

• Abdominal pain

• Rectal bleeding/ blood in your stools

• Unintentional weight loss

• Fatigue

  
  

  Diagnosis:

  IBD can be confirmed by a doctor after either an endoscopy or colonoscopy (or combination) and imaging analysis such as MRI or CT scans. Health professions may also check stool samples and blood tests to check that symptoms are not from infection.

  
  

  Treatment:

  Medication can be sued to manage symptoms of IBD by lowering inflammation, this can reduce abdominal pain and diarrhoea. These medications include aminosalicylates, corticosteroids, immunomodulators, antibiotics and other biological agents.

  In severe cases where medication is insufficient to control symptoms, sufferers may require surgery to resume a healthier and more active lifestyle.

  
  

  References

  
  

  Jenifer K Lehrer et al. (2019) What is the Rome IV criteria for diagnosis of irritable bowel syndrome (IBS)? Department of Gastroenterology, Jefferson Health System Torresdale Campus, Philadelphia.

  
  

  How do FODMAPs Trigger IBS Symptoms? https://www.monashfodmap.com/blog/the-fodmap-grand-tour-down-under-ibs/, The Monash FODMAP Team, Dec 18, 2015.

  
  

  https://www.cdc.gov/ibd/what-is-IBD.htm

  
  

  https://www.crohnsandcolitis.com.au/