Home' Australian Pharmacist : Australian Pharmacist October 2012 Contents Australian Pharmacist October 2012 I © Pharmaceutical Society of Australia Ltd.
1. Choose the INCORRECT statement.
a) Symptoms of inflammatory bowel
disease include fever, mouth ulcers,
weight loss and fatigue.
b) Most cases of gastroenteritis are
characterised by the acute onset of
watery diarrhoea and/or vomiting.
c) Bloating, headache and wheezing are
typical symptoms of irritable bowel
d) Abdominal pain associated with
appendicitis tends to be aggravated by
cough and movement.
2. Choose the INCORRECT statement.
a) Osteoporosis is a potential long-term
complication of coeliac disease.
b) It is difficult to achieve a diet
completely devoid of gluten.
c) The amount of gluten that people with
coeliac disease can tolerate varies.
d) A blood test and small bowel biopsy
are used to diagnose coeliac disease.
3. Which of the following is NOT an
atypical sign or symptom of coeliac
a) Mucus in the stools.
b) Recurrent mouth ulcers.
c) Iron-deficiency anaemia.
4. Coeliac disease:
a) results in damage to the small
b) does not affect children.
c) increases the absorptive capacity of
the small intestine.
d) can be triggered by emotional stress.
5. Choose the CORRECT statement
a) A gluten-free diet will not achieve
complete resolution of symptoms.
b) The safe gluten threshold is the same
for all people with coeliac disease.
c) Gluten or excipients derived from
gluten-containing grains must always
be declared on the medicine label.
d) None of the above.
gluten-containing excipients in her Doryx
capsules. You explain that medicines can
contain very small amounts of gluten but
that, in some people, only a very small
amount of gluten is enough to trigger a
reaction and cause symptoms. You explain
that there is an alternative gluten-free
brand of doxycycline available if necessary
but you advise her to continue taking the
medicine until her doctor has confirmed
the cause of her symptoms.
Katerina returns the following week with a
new prescription for doxycyline. She tells
you that she has seen her doctor and he has
performed some blood tests. He has also
booked her in to have a gastroscopy to test
for intestinal damage which would indicate
coeliac disease. Her doctor explained that
a correct diagnosis is important because
of the long-term health effects associated
with coeliac disease. In the meantime,
her doctor has suggested she change to
a gluten-free brand of doxycycline to see
whether her symptoms improve, and to
continue with a gluten-free diet.
Advice for consumers
• Consult a doctor if you suspect you have
• Do not trial a gluten-free diet to
• See a dietitian with experience in gluten-
free diet for information and advice.
• Do not stop taking medicines if you
suspect or discover that they contain
gluten; ask your doctor for advice.
• A strict lifelong gluten-free diet is
required for ALL people diagnosed with
• Vitamin and mineral supplementation
may be necessary if deficiencies develop.
• Bone density tests are recommended for
adults with coeliac disease.
• Join the Coeliac Society Australia for
information and support.
1. 1 . The Merck Manual. Whitehouse Station: Merck Sharp &
Dohme; 2011. At: www.merckmanuals.com
2. 2 . Rangasamy P. Crohn Disease [revised Jun 2011]. Medscape
Reference. At: http://emedicine.medscape.com/article/172940
3. 3 . Gibson PR, Iser J. Inflammatory bowel disease. Aust Fam Phys
4. 4 . eTG complete. Melbourne: Therapeutic Guidelines; 2012.
5. 5 . Helm CW. Ovarian cysts [revised Aug 2012]. Medscape
Reference. At: http://emedicine.medscape.com/article/255865
6. 6 . Moore Shepherd S. Pelvic Inflammatory Disease [revised May
2011]. Medscape Reference. At: http://emedicine.medscape.
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emergency contraceptive pills: a systematic review. Obstet
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8. 8 . NSW Food Authority. Allergy and intolerance [revised May
2012]. At: www.foodauthority.nsw.gov.au
9. 9 . Australasian Society of Clinical Immunology and Allergy.
Food intolerance [revised Jan 2010]. At: www.allergy.org.au/
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Reference. At: http://emedicine.medscape.com/article/171805
11. 11 . Anderson RP. Coeliac disease. Aust Fam Phys
12. 12. Jones S, D’Souza C, Haboubi NY. Patterns of clinical
presentation of adult coeliac disease in a rural setting. Nutrition
13. 13. Lionetti E, Catassi C. New clues in celiac disease
epidemiology, pathogenesis, clinical manifestations,
and treatment. International Reviews of Immunology
14. 14 . Wakim-Fleming J. Celiac disease and malabsorptive
disorders. 2011. At: www.clevelandclinicmeded.com
15. 15. Plogsted S. Medications and celiac disease – tips from a
pharmacist. The Celiac Diet, series 5. Practical Gastroenterology
2007. At: www.medicine.virginia.edu/clinical/departments/
16. 16. Gluten Intolerance Group of North America. GIG’s
Gluten-free diet and drug instruction. 2011. At: www.gluten.
17. 17 . Maltin V, Charabaty A, Mangione R. Medications: a hidden
source of gluten. Celiac disease: a comprehensive review and
update, series 4. Practical Gastroenterology 2009;32–8 .
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disease. US Pharm 2011;36(12):30–33 .
19. 19. Akoben AL, Thomas AG. Systematic review : tolerable
amount of gluten for people with celiac disease. Aliment
Pharmacol Ther 2008;27(11):1044–52 .
20. 20. Catassi C, Fabiani E, Iacono G, et al. A prospective, double-
blind, placebo-controlled trial to establish a safe gluten
threshold for patients with celiac disease. Am J Clin Nutr
21. 21. Therapeutic Goods Order No. 69 – General requirements
for labels for medicines. 2001. At: www.comlaw.gov.au/Details/
Key learning points
• Pharmacists can help reduce the
time to diagnosis by being aware
of the signs and symptoms of
coeliac disease, and the possibility
that people with undiagnosed
disease may visit the pharmacy for
• Some pharmaceutical products
contain trace amounts of gluten.
Ingestion of medicines with excipients
derived from gluten should generally
be avoided in people with coeliac
disease. The cumulative effect of
inadvertent ingestion of gluten from
different sources (e.g. unknowingly
eating foods contaminated with
gluten) may exceed the person’s
threshold for triggering symptoms
and causing intestinal damage.
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