DISPENSER EDUCATION MODULE: COELIAC DISEASE

This training, available free and exclusively to DDA members, is designed to provide practice dispensary staff with background information on coeliac disease and advice to support patients with the condition. Throughout this training, you will find various activities to help Aims of this module reinforce your learning. Ten, multiple choice questions at the end will help you identify any areas needing a quick recap.  know what coeliac disease is and the

symptoms it can cause Coeliac disease explained Symptoms  appreciate risk factors for the development of

According to the charity Coeliac the condition Because the small intestine is UK, around one in every hundred under attack in coeliac disease, it  be aware of how coeliac people in the UK has coeliac is unsurprising that symptoms disease is diagnosed disease. However, only 30 per such as diarrhoea, indigestion,  understand how it is cent of people with coeliac bloating, pain and constipation managed. disease are currently diagnosed: occur. However, as the villi leaving around half a million become more damaged, they . people undiagnosed start to flatten, which causes fewer nutrients to be absorbed Who’s at risk? Coeliac disease is an autoimmune from the diet. condition in which proteins in the diet cause antibodies to be made This can lead to a whole new set It isn’t really properly understood by mistake, which then attack the of problems, for example, mouth why some people experience the tiny finger-like villi that line the ulcers, weight loss, tiredness, strong immune response to small intestine. This causes the anaemia, fertility issues, impaired gluten that leads to the organ to become inflamed and growth, delayed puberty development of coeliac disease, damaged. peripheral neuropathy, but there is certainly a strong osteoporosis and skin rashes. genetic link: Nice recommends Other complications listed by the that first-degree relatives of Activity one National Institute for Health and someone diagnosed with coeliac Look at the difference Care Excellence (Nice) disease are offered testing for between healthy and include:osteoporosis, ulcerative the condition. coeliac villi in the small jejunitis, malignancy (intestinal intestine lymphoma), functional Other factors that appear to hyposplenism, vitamin D increase the risk of coeliac deficiency and iron deficiency. disease include having another autoimmune condition such as The dietary protein that triggers thyroid disease or type 1 this immune response is gluten, diabetes, having a neurological which is found in wheat, barley condition such as epilepsy, and and rye; some people are also Activity two certain genetic syndromes such sensitive to the slightly different Have another look at the as Turner’s and Down’s. protein that is present in oats. difference between normal However, it is important to note and coeliac-damaged villi. that gluten sensitivity is not the Activity three Why do you think same as coeliac disease: while What is peripheral absorption of nutrients can the symptoms are similar, in neuropathy? Check your be affected in severe or gluten sensitivity there is no response damage to the lining of the gut. prolonged cases?

Non-tropical sprue, coeliac sprue, and gluten-sensitive enteropathy are other terms sometimes used for coeliac disease. started while waiting for Only oats labelled as gluten-free endoscopy as this can result in are suitable for people with Activity four false negative results. coeliac disease as other oats can What do you understand by be contaminated with gluten- the terms “first-degree containing grains. A small relative” and “second-degree Managing coeliac disease percentage of people with relative”? If you need to, coeliac disease are sensitive to read the definitions Getting the symptoms of coeliac avenin, a protein similar to gluten disease under control and then which is found in all oats, kept in check hinges on one including gluten-free oats. thing: avoiding gluten for life. Information and support are vital Diagnosing coeliac disease Activity eight if people are to understand which foods contain the protein For more alternatives, take Nice recommends that coeliac and how to avoid it when eating a look at the gluten-free disease testing should be offered inside and outside the home - checklist published by to anyone who has unexplained while still getting all the nutrition Coeliac UK abdominal or gastrointestinal required to stay healthy. symptoms, prolonged tiredness, Foods that cannot be eaten unexpected weight loss, irritable bowel syndrome, faltering Fortunately, foods are required Activity six growth, severe mouth ulcers, a to state all deliberate ingredients A gluten-free way of life can first degree relative with the on the packaging. Gluten be a challenge for an adult, condition, or low levels of iron, containing cereals must be but even more so for a child. vitamin B12 or folic acid for no emphasised in the ingredients Coeliac UK offers this advice apparent reason. list, for example in bold lettering. for parents The Crossed Grain symbol and/or Nice also advises testing patients the wording ‘gluten-free’ who have just been diagnosed identifies products that are with type 1 diabetes or gluten-free. autoimmune thyroid disease, and include anything based on wheat, Naturally gluten-free food swaps states that it should be rye barley or oats: bread, flour, are a good way to avoid considered an option for cakes, pastries and biscuits; seemingly endless scrutiny of individuals with bone disorders wheat varieties such as spelt, food packaging, and can avoid such as osteopenia, defects in semolina and kamut. This will often premium-priced gluten- dental enamel, unexplained include ingredients used as free alternatives for example: fertility issues or recurrent fillers, flavouring or thickeners, miscarriage, neurological for example, sausages, sauces,  rice rather than pasta symptoms such as peripheral soups and ready meals. As beer is neuropathy, unusual liver test  jacket potato rather than made from gluten-containing sandwich results and certain genetic grains it is also unsuitable, syndromes.  cheese salad rather than although but gluten-free beers cheese and crackers. are available.

Activity five The availability of gluten-free Why might someone products on prescription differs who has already been according to where you are in the diagnosed with coeliac Activity seven country, and even between disease undergo the Watch the Food Standards localities. investigations detailed Agency video and read the NHS England, for above? Read this information on allergens example, only allows certain explanation breads and bread mixes to be prescribed, but not other People with coeliac disease also products such as pasta, flour, need to be aware of the risk of The tests involve measuring the cake mixes and biscuits. In food cross-contamination, for levels of certain immunoglobulins Scotland, Wales and Northern example, chips cooked in the and enzymes in the blood. A Ireland, there are fewer gluten-free diet should not be same oil used for battered fish. restrictions.

Activity nine Do you know what gluten-free items can be prescribed and Put your how the process works in your area? if not, ask one of the doctors for more details

Nice recommends that all

patients with coeliac disease are monitored annually once stabilised and more frequently before reaching this point. To the test Appointments can take place at Tick the correct answer. If the GP surgery, and should you need help, why not include a measurement of weight re -read the training? and height, plus a discussion of If you get at least eight symptoms and adherence to a questions right, you can gluten-free way of life. This also Return to the main menu for provides an opportunity to download a CPD portfolio this DEM to access the links identify anyone who may need certificate for your line to the answers and your referring, perhaps, because of 1) In the UK, manager to sign. downloadable certificate

concerns about persistent or around 10 per cent of

recurrent symptoms, or other people have coeliac associated health problems such 5) Which of the following disease: as bone disease. increases the risk of a) True developing coeliac b) False? disease?

a) Delaying the introduction Activity ten 2) Which of the following is What questions would you of gluten during infant not a synonym for coeliac recommend someone with weaning disease? coeliac disease ask at their b) Family history annual review? See what a) Wheat intolerance c) Obesity Nice says b) Non-tropical sprue

c) Gluten-sensitive 6) According to Nice, which enteropathy. of the following

individuals should be 3) In coeliac disease, the tested for coeliac villi of the large intestine disease? become damaged: a) A man with a duodenal a) True ulcer b) False? b) A woman recently

diagnosed with type 2 4) Which of the following is diabetes not a common symptom c) A woman with recurrent of coeliac disease? mouth ulcers a) Acid reflux

b) Constipation

c) Diarrhoea

7) Someone who is being 9) Which of the following investigated for coeliac should not be eaten or disease should exclude drunk by someone with gluten from their diet for coeliac disease? the six weeks before they a) Cider are tested: b) Jelly a) True c) Rye bread b) False? 10) Gluten-free foods are 8) Avoiding gluten is the often more expensive principle way in which than the food they are coeliac disease is designed to replace: managed: a) True a) True b) False? b) False? 2 hours

For your notes