Websites relating to coeliac disease

Websites related to this week's Clinical Review selected by Dr Keith Barnard.

DUODENUM JOURNEY

This site complements the website of the week nicely, and is rather bizarre - certainly quirky enough to deserve a quick visit if you want brightening up on a dreary morning.

The video clip of a journey down a coeliac-affected duodenum opens with bongo drums, and you then travel down to a musical accompaniment. That in itself is quite strange, but the chosen piece is a brisk folk tune that sounds as if it should be accompanied by the slapping of lederhosen rather than an exploration of the small bowel.

See what you think.

Why go there: entertaining.
Downside: none.
Information from: Gastrolab, Finland.
Address: www.netikka.net/hans.
bjorknas/pan-055.htm

LIVER DISEASE LINK

This interesting paper discusses the link between liver disease and coeliac disease. It is possible to sum up its message in a few sentences.

Coeliac and liver disease share common risk factors, and the consequences of coeliac disease can cause liver dysfunction. Because of this, liver dysfunction should be sought in coeliac disease, and its aetiology explored when abnormalities persist after gluten exclusion.

GPs should exclude coeliac disease in patients with unexplained liver dysfunction before labelling them cryptogenic. There is a useful flow chart to show how to investigate biochemical liver dysfunction in these circumstances.

Why go there: learn an interesting lesson.
Downside: narrow spectrum of interest.
Information from: Archives of Disease in Childhood.
Address: http://adc.bmjjournals.com/cgi/content/full/87/4/293

USEFUL OVERVIEW

This four-page PDF gives an excellent summary of all the relevant details of coeliac disease. It comes from an Australian physician whose smiling face greets you on the first page.

It defines the condition, discusses the role of gluten and has a useful table of the co-morbidities associated with the disease. There are tables summarising investigations, atypical forms, and making the diagnosis.

Causes of non-compliance are also listed.

Well worth printing off for reference.

Why go there: all you need to know.
Downside: none.
Information from: Australian Family Physician Journal.
Address:
www.racgp.org.au/afp/downloads/pdf/april2005/20050329anderson.pdf

PRESCRIBING GUIDE

I was a little suspicious when I first saw this gluten-free prescribing guide because it was produced with the help of involved industries. However, the main contributors turned out to be eminent figures from the coeliac disease working group of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition, and it is supported by the British Dietetic Association, so my faith was restored.

This is a beautifully presented 16-page PDF that will help any GP involved in gluten-free food prescribing. There is also a version for patients.

Why go there: excellent aid to prescribing.
Downside: none.
Information from: Good Relations Healthcare.
Address: http://www.glutenfreefood.co.uk

PATIENT INFORMATION

I was not too impressed with this UK charity site, but it's a case of Hobson's choice.

The front page is busy and festooned with advertisements, and there are funny noises and annoying pops when you click on the links. When someone visits a site like this, top of their list is probably information about their condition, and that should be given priority. But here employment, donations and a host of other topics have equal prominence.

However there are redeeming features, and the information is there if you look for it. One excellent feature is that you can check for hotels and restaurants that serve gluten-free meals.

Why go there: a well-supported UK charity.
Downside: messy home page.
Information from: Coeliac UK.
Address: www.coeliac.co.uk/

- Dr Barnard is a former GP in Fareham, Hampshire

- Clinical Review, page 33

WEBSITE OF THE WEEK

You can describe what the various parts of the intestine are like in coeliac disease until you are blue in the face, but the only way to really understand is to look down an endoscope. And that is what you can do on this site, with no less than 21 different views showing how the disease affects the mucosal lining of various parts of the duodenum.

The damage to the duodenum when the condition is untreated is clearly seen in these quality images. The only problem is that there is little clinical information here, and you have to link to another part of the site for this, where you will also find a self-test quiz that offers hints if you are stuck.

Why go there: see what it looks like.
Downside: not enough clinical information.
Information from: Gastrolab.
Address: http://www.gastrolab.info/tvvm26.htm

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