The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

Letter to the editor

Editor, – Recently you published articles on irritable bowel syndrome (Aust Prescr 2001;24:68-71) and oesophageal reflux (Aust Prescr 2001;24:110-2). Over the years, these diagnoses have been made by three gastroenterologists as a consequence of my epigastric reflux and colonic pains. A fourth endoscopy has now found evidence of coeliac disease in a duodenal biopsy. Since going on a gluten-free diet I am gaining weight. (Over the years, despite having a healthy appetite, I was close to being almost anorexic in appearance and my mental and physical energy was below average.) Now the pains have disappeared and I am feeling and reacting in a more appropriate way. (Even my tennis has improved!)

I write to tell your readers that coeliac disease is the 'great imitator'. It was late in life (I am 80) that it was discovered. As a student I suggested to a general practitioner that I had a malabsorption syndrome but this was discounted. (Lesson: listen to the patient.) A pathologist tells me that the physiology of the whole gastrointestinal tract is disturbed in coeliac disease. Pains, dysfunction, aphthous ulcers and bowel disturbances are the result. I now hear of increasing numbers of patients like myself being diagnosed late in life, after their symptoms had been diagnosed as something else. One wonders how many patients have had surgery and/or medications when the correct management should have been a small bowel biopsy1 followed by a gluten-free diet.

Bill Woods
Radiologist
Wahroonga, NSW