Start gluten free diet

You discuss the results with Davina’s parents. You explain that the antibody tests show that she has antibody’s against gluten, which is a protein found in wheat, so is present in bread, pasta, biscuit. This finding, combined with her poor weight gain, is very suggestive of coeliac disease, which is an allergic condition of the small intestine. In this condition, the lining of the intestine becomes inflamed because of the gluten in the diet. The consequence of this is that the intestine does not absorb nutrients properly.

The parents ask you what can be done about this.

You explain that she will need to go on a diet without gluten. Then her gut will stop being inflamed and start absorbing properly again. The new diet will need to continue lifelong.

A biopsy would establish even more certainly that Davina has coeliac, but this would require an anaesthetic and an invasive procedure. One can try to see what effect the diet change has before considering the biopsy.

Davina’s parents are happy with this plan, and so you refer her to the dietician, who is able to see them in a week’s time.

Two months later you see Davina again in the clinic.

The appointment with the dietician went well and Davina’s parents learnt what to offer that was gluten free. Unfortunately Davina did not take well to this new diet and refused many of the gluten free items. In order for her to get some calories into her, she has been having some (normal wheat) bread and biscuits.

In herself the parents report an improvement – she is less irritable and her frequency of stool better too.

Less impressive is her weight, which has only increased by 100g since her last visit.

You explain that she will now need to be seen by the gastroenterologist for further management. Her parents are pleased that someone will at last be getting to the bottom of the problem.