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Coeliac Awareness Week - What if it isn't Coeliac Disease?

Some people may experience the symptoms related to gluten sensitivity that occur in Coeliac Disease but blood and biopsy tests do not confirm Coeliac Disease as a diagnosis. The main difference is the lack of damage to the small intestine, and no real indication of how the immune system may be involved. Despite a lack of diagnosis, the symptoms remain very real for the sufferer, and it’s important for healthcare professionals to support patients to help find a solution, or to ease the symptoms.
With 15% of households in the UK choosing to go ‘gluten-free’ there is certainly a great deal of interest in following a gluten free diet. Whether it is an appropriate diet for the majority is yet to be determined but there are certainly other gastrointestinal conditions where gluten is thought to be a potential trigger.

**Non Coeliac Gluten Sensitivity**

Where Coeliac Disease is ruled out through diagnostic tests, but eating gluten containing foods still continues to be an issue, this can often be referred to as Non Coeliac Gluten Sensitivity. There is still much debate around what this really means, and whether gluten really is the trigger for the symptoms experienced.

It is possible that removing gluten from the diet also removes other potentially damaging components. Interest has focussed recently on Fermentable Oligo Di Monosaccharies and Polyols (FODMAPs) or possibly the non gluten part of wheat. Further research is required to fully understand the role of gluten in non coeliac gluten sensitivity.

**Wheat or Gluten Intolerance**

Although different to Coeliac Disease in terms of the disease progression, people who are intolerant to wheat or gluten may experience similar symptoms. Interestingly, someone with wheat intolerance may continue to experience problems even if they follow a gluten free diet. This is because the remaining part of the wheat in the product may be affecting them. They may, or may not, also be able to eat barley, rye and oats without any problem, and may also be able to reintroduce wheat into the diet after a short period of elimination.

This type of intolerance is more difficult to diagnose because there is no simple test that is available. For most people, removal of gluten and wheat from the diet for a short period of time may help with symptoms. Under the advice of a Dietitian, gradual reintroduction of wheat and gluten may help to identify which foods may be problematic.

**Irritable Bowel Syndrome (IBS)**

Irritable Bowel Syndrome is a common long term condition of the gastrointestinal tract. Symptoms vary between individuals but tend to be linked to digestive comfort such as stomach cramps, diarrhoea and/or constipation.

The symptoms tend not to be continuous but can last for days or months at certain points of the individuals life. People tend to have triggers which can set off symptoms including stress or eating certain foods.

Unlike Coeliac Disease people with IBS do not suffer any damage to the small intestine, although they may experience inflammation at times. There is also no one diagnostic test, or treatment route for IBS which makes it a challenging condition.

If you experience any gastrointestinal symptoms on a regular basis, your GP should always be the first point of call. You may be referred to a Dietitian who will take a detailed dietary history, and may ask you to keep a food and symptoms diary to try and ascertain any link.

Managing the symptoms of IBS is very individual but it is thought that certain changes to the diet may help. These include:-

- Changing the amount of fibre in your diet depending on your symptoms
- Choosing a low FODMAP diet – this requires a decrease in foods
containing the FODMAP carbohydrates described above. It is a complex diet and should only be done under medical supervision.

**Moving Forward**

Whatever symptoms you are experiencing, you should always discuss this with your GP before taking any action. Although you may find symptoms improving by following a gluten or wheat free diet, for example, its important for diagnosis to keep your diet habitual. Once a diagnosis of Coeliac Disease has been ruled out (this has to be done whilst gluten is part of the diet), then your GP or gastroenterologist will advise on next steps and the best course of action.

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