Treatment

Coeliac disease is usually treated by simply excluding foods that contain gluten from your diet.

This prevents damage to the lining of your intestines (gut) and the associated symptoms, such as Traveller's diarrhoea and stomach pain .

If you have coeliac disease, you must give up all sources of gluten for life. Your symptoms will return if you eat foods containing gluten, and it will cause long-term damage to your health.

This may sound daunting, but your GP can give you help and advice about ways to manage your diet. Your symptoms should improve considerably within weeks of starting a gluten-free diet. However, it may take up to two years for your digestive system to heal completely.

Your GP will offer you an annualreviewduring which your height and weight will be measured and your symptoms reviewed. They'll also ask you about your diet and assess whether you need any further help or specialist nutritional advice.

A gluten-free diet

When you're first diagnosed with coeliac disease, you'll be referred to adietitian tohelp you adjust to your new diet without gluten. They can also ensure your diet is balanced and contains all the nutrients you need.

If you have coeliac disease, you'll no longer be able to eat foods that contain barley, rye orwheat, including farina, graham flour, semolina, durum,cous cous and spelt.

Even if you only consume a small amount of gluten, such as a spoonful of pasta, you may have very unpleasant intestinal symptoms. If you keep consuming gluten regularly, you'll also be at greater risk ofdeveloping osteoporosis and cancer in later life.

Many gluten-free alternatives are widely available in supermarkets and health food shops, including pasta, pizza bases and bread. A range of gluten-free foods is also available on prescription.

Many basic foods such as meat, vegetables, cheese, potatoes and rice are naturally free from gluten so you can still include them in your diet. Your dietitian can help you identify which foods are safe to eat and which aren't. If you're unsure, use the lists belowas a general guide.

Foods containing gluten (unsafe to eat)

If you have coeliac disease, don't eat the following foods, unless they're labelled as gluten-free versions:

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

It's important to always check the labels of the foods you buy. Many foods particularly those that are processed contain gluten in additives, such as malt flavouring and modified food starch.

Gluten may also be found in some non-food products, including lipstick, postage stamps and some types of medication.

Cross-contamination can occur if gluten-free foods and foods that contain gluten are prepared together or served with the same utensils.

Gluten-free foods (safe to eat)

If you have coeliac disease, you can eat the followingfoods, which naturally don't contain gluten:

• 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 can contain no more than 20 parts per million (ppm) of gluten.

For most peoplewith coeliac disease, these trace amounts of gluten won't cause a problem. However, a small number of people are unable to tolerate even trace amounts of gluten and need to have a diet completely free from cereals.

The Coeliac UKwebsite has moreabout the law on gluten-free , as well as information and advice about a gluten-free diet and lifestyle .

Oats

Oats don't contain gluten, but many people with coeliac disease avoid eating them because they can become contaminated with other cereals that contain gluten.

There's also some evidence to suggest that a very small number of people may still be sensitive to products that are gluten-free and don't contain contaminated oats. This is because oats contain a protein called avenin, which is suitable for the majority of people with coeliac disease, but may trigger symptoms in a few cases.

If, after discussing this with your healthcare professional, you want to include oats in your diet, check the oats are pure and that there's no possibility contamination could have occurred.

You should avoid eating oats until your gluten-free diet has taken full effect and your symptoms have beenresolved. Once you're symptom free, gradually reintroduce oats into your diet.If you develop symptoms again, stop eating oats.

Advice on feeding your baby

Don't introduce gluten intoyour baby's diet beforethey'resix months old. Breast milk is naturally gluten free as are all infant milk formulas.

If you have coeliac disease, Coeliac UK recommends foods containing gluten areintroduced gradually when a child is six months old. This should becarefullymonitored.

The Coeliac UK website provides support for parents .

Other treatments

As well as eliminating foods that contain gluten from your diet, a number of other treatments are available for coeliac disease. These are described below.

Vaccinations

In some people, coeliac disease can cause the spleen to work less effectively, making you more vulnerable to infection.

Youmay therefore need to have extra vaccinations, including:

• flu (influenza) jab
• Hib/MenC vaccine , which protects against sepsis (blood poisoning), pneumonia and meningitis (an infection of the lining of the brain)
• pneumococcal vaccine , which protects against infections caused by the Streptococcus pneumoniae bacterium

However, if your spleen is unaffected by coeliac disease, these vaccinations aren't usually necessary.

Supplements

As well as cutting gluten out of your diet, your GP or dietitian may also recommend you take vitamin and mineral supplements, at least for the first six months after your diagnosis.

This will ensure you get all the nutrients you need while your digestive system repairs itself. Taking supplements can also help correct any deficiencies, such as anaemia (a lack of iron in the blood).

Dermatitis herpetiformis

If you have dermatitis herpetiformis (an itchy rash that can be caused by gluten intolerance), cutting gluten out of your dietshould clear it up.

However, it can sometimes take longer for a gluten-free diet to clear the rash than it does to control your other symptoms, such as diarrhoea and stomach pain.

If this is the case, you may be prescribed medication to speed up the healing time of the rash. It's likely that this will be a medicine called Dapsone, which is usually taken orally (in tablet form) twice a day.

Dapsone can cause side effects, such as headaches and depression , so you'll always be prescribed the lowest effective dose.

You may need to take medication for up to two years to control dermatitis herpetiformis. After this time, you should have been following a gluten-free diet long enough for the rash to be controlled without the need for medication.