Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the witnesses. Everybody knows somebody who is a coeliac or is aware of somebody who is a coeliac and we are probably all conscious of the broader issues around the disease itself but when we outline the impact it can have on individuals, the difficulties with lifestyle in terms of requiring a gluten-free diet, and the lack of resources and supports for sufferers of coeliac disease, it is clear it is an issue that has to be addressed in the context of resourcing.

The witness said that approximately 1% of the western European population is diagnosed with coeliac disease. We do not have that rate in Ireland so either we are not diagnosing or are hereditarily different from the rest of western Europe, which is unlikely. Why is that the case in view of the fact that we know a good deal about the disease, that we have a poor detection rate and a poor diagnosis rate? What are the reasons for that?

A seriological blood test can be done to diagnose coeliac disease, and duodenum biopsies can be performed also. Are people presenting with the symptoms and not being followed up in terms of the diagnosis? Are general practitioners mistaking irritable bowel syndrome for coeliac disease? All of those issues have to come into play. We all talk about primary care settings as the front line in terms of the provision of health care but if we are not diagnosing at the rate that should be anticipated in a normal population it is clear there are problems at the coalface in terms of detection and diagnosis. What can be done in those particular areas to address that?

In terms of the health implications of non-diagnosis, the witness referenced vitamin absorption. That is a critically important area in women of child-bearing age whereby mineral deficiencies can cause problems initially in getting pregnant and also during pregnancy. Should we have a greater awareness programme among our health professionals and equally among the broader population?

On the issue of the dietetic services, coeliacs are not alone in having poor dietetic services. We have poor dietetic services in general, which are under-resourced. We have not taken that issue seriously, not only in terms of coeliac disease but in obesity and many other areas.

There is also an obligation on the owners of food outlets. When the witness mentioned institutions I presume he was referring to hospitals, large institutions and, equally, the small restaurant on the side of the street. Should there be some form of inspection process through the Food Safety Authority, for example, whereby when it is inspecting other areas there are clear protocols for ensuring there is non-contamination and that the staff are informed of their obligations to ensure they have gluten-free diets available but, more importantly, if they are providing those diets that they are done in a way that there is no potential for contamination? I am merely posing the question. In terms of food safety in general, is this not something that should be examined to ensure we protect those who have been diagnosed with this disease?

The witness said that nine out of ten people who are using gluten free products do not have coeliac disease but if someone is using gluten free products it is difficult to detect whether they have coeliac disease because they are not showing with the symptoms. People who have irritable bowel syndrome might hear from another person that if they follow a gluten free diet they will get better. They may never have been diagnosed with coeliac disease but they had the symptoms and dealt with them themselves and if the witnesses' organisation does the test, obviously it will not diagnose as many people.