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How do you determine if a patient has gluten or wheat intolerance?

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How do you determine if a patient has gluten or wheat intolerance?

Self-diagnosed wheat intolerance and “gluten reactions” have become very common indeed almost fashionable!

Coeliac disease is a specific clear cut inflammatory reaction to gluten which is a component of Gliden in wheat  flour. 90-95% of coeliac patients will have positive antibody tests. The best antibody tests are Tissue Transglutaminase Autoantibodies (TGAA) and Endomysial Antibodies (EMA).  In children under two IgA antigliden antibody is more reliable.  A SMALL BOWEL BIOPSY is necessary to make a definitive diagnosis.

A normal small bowel biopsy in a patient on a gluten free diet does NOT exclude coeliac disease. A small number of patients with normal small bowel biopsies will subsequently develop clinical coeliac disease (for details see The Gut Foundation web site (gut.nsw.edu.au).

Wheat intolerance is a very non-specific reaction, undoubtedly there are some people who have a variety of symptoms including abdominal bloating, excess intestinal gas, abdominal cramps and diarrhoea which are precipitated by wheat ingestion. This appears to be an intolerance to the whole wheat flour protein not to gluten. Food intolerances in general are a very difficult area. If patients feel that their symptoms are reduced by a wheat free diet there is no reason not to follow one.  They do not need to be on a gluten free diet. Unfortunately, food intolerances often change overtime. Serial elimination diet studies confirm this (for more information on food intolerances see the Gut Foundation website and the publication “Friendly Foods” by the Royal Prince Alfred Hospital, Sydney, Department of Dietetics).