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Feature Christmas 2019: Express Yourself

What your patient is drawing

BMJ 2019; 367 doi: (Published 16 December 2019) Cite this as: BMJ 2019;367:l6431

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Re: What your patient is drawing: Type 1 Diabetes, coeliac disease and ‘can I still eat pasta?!’

What your patient is drawing: Type 1 Diabetes, coeliac disease and ‘can I still eat pasta?!’

Emma Yarwood. Occupational Therapist, patient with coeliac disease and photographer
David S Sanders. Professor of Gastroenterology and Chairman of Health Advisory Board for Coeliac UK.

We found the images of Tony Pickering inspiring and thought provoking. Coeliac Disease and Type 1 Diabetes are both autoimmune diseases and have shared genetic coding. Coeliac disease affects 1% of the population but the majority of cases are unrecognised (1). Once a person is diagnosed with coeliac disease quite uniquely for autoimmune diseases the T cell mediated immune response can be switched off by withdrawing gluten and your symptoms generally resolve. However, when an individual is then inadvertently exposed to gluten the immunological and symptomatic response can be more severe. Patients have worked this out for themselves and share information about restaurants and eating out within their community. However, gluten is ubiquitous and this results in a significant reduction of quality of life for patients with coeliac disease (2). Eating for most of us, occurs three times per day and is an important social event. Fear of ‘being glutened’ results in reduced social contact both in terms of visiting friends or eating outside of your house (3,4). Under those circumstances the question ‘can I still eat pasta?’ may take on a whole new significance.

1. Mooney PM, Hadjivassiliou M, Sanders DS. Coeliac Disease Clinical Review BMJ 2014 Mar 3;348:g1561. doi: 10.1136/bmj.g1561
2. Barratt SM, Leeds JS, Sanders DS. Quality of life in coeliac disease is determined by perceived degree of difficulty adhering to a gluten-free diet, not the level of dietary adherence. J Gastrointestin Liver Dis 2011;20(3):241-5.
3. Barratt SM, Leeds JS, Sanders DS. Factors influencing the type, timing and severity of symptomatic responses to dietary gluten in patients with biopsy-proven Coeliac Disease. J Gastroinest Liv Dis 2013;22(4):391-6.
4. Karajeh MA, Hurlstone DP, Patel T, Sanders DS. Chefs' knowledge of coeliac disease (compared to the public): a questionnaire survey from the United Kingdom Clin Nutr 2005;24:206-10.

Competing interests: No competing interests

31 December 2019
David S Sanders
Professor of Gastroenterology
Emma Yarwood
Sheffield Teaching Hospitals & University of Sheffield
Royal Hallamshire Hospital, Glossop Road, Sheffield, UK.