Celiac disease 0
Celiac disease

Celiac disease: causes, symptoms, research. Treatment of celiac disease

Celiac disease, or celiac disease, is an autoimmune disease caused by gluten intolerance. It is estimated that about 1-2% of the population suffer from it, although these statistics are probably underestimated - the variety of symptoms and the insidious course of celiac disease mean that a large proportion of cases remain undiagnosed. Find out what causes celiac disease, what symptoms of celiac disease are most characteristic, and what tests can be used to diagnose it. Is the treatment of celiac disease just a diet?

Celiac disease, or celiac disease, belongs to the group of autoimmune diseases, i.e. those in which the immune system mistakenly recognizes the body's own tissues as foreign. This creates an immune response aimed at destroying them. In celiac disease, the organ against which the abnormal response of the immune system is directed is the small intestine.

Celiac disease usually manifests itself in childhood. But it can also appear in adulthood - usually between the ages of 35 and 55, sometimes later. It teases women twice as often as men. It can develop asymptomatically and then we find out about it by accident or we are not aware that we have it. Research shows that 30 percent of adults diagnosed with celiac disease went through a mild form of celiac disease in the first few years of life, but the disease was not diagnosed at the time.

The causes and mechanism of the development of celiac disease

The disease develops through several mechanisms. The first important factor is genetic predisposition - the vast majority of patients suffering from celiac disease have a specific set of genes (the so-called DQ2 or DQ8 haplotype).

Consuming gluten - a mixture of proteins found in wheat, rye, barley and their derivatives - triggers their immune system stimulation, consisting in the production of various antibodies and an inflammatory response. The result of these changes is the destruction of the structure and disruption of the functioning of the small intestine.

Typically, there is atrophy of the villi, i.e. the natural folds of the mucosa. In addition, the activity of digestive enzymes is reduced. These changes result in disturbances in the digestive process of food and the absorption of nutrients.

Celiac characters. Symptoms and course of the disease

Celiac disease can take several clinical forms, causing different types of symptoms. The typical course of the disease is associated primarily with the disturbances in intestinal malabsorption and their consequences.

On the other hand, latent and atypical forms of celiac disease, in which it happens that it is impossible to make a correct diagnosis for many years, are a much more diagnostic challenge.

Due to the course of the disease, we can distinguish the following forms of celiac disease

Classic celiac disease :

The classic form most often appears in young children. It is estimated that only about 30% of cases of the disease are manifested in a classic way. The most common symptoms include:

  • stomach pain
  • flatulence
  • chronic diarrhea

Inadequate absorption of nutrients can slow down a child's development. Impairment of fat digestion, on the other hand, results in their presence in the stool (the so-called fatty stools).

Reduced iron absorption causes anemia.

There may also be vitamin deficiencies (mainly vitamin A, vitamin D, vitamin E, and vitamin K).

Neglected figure of celiac disease

If, despite the diagnosis of celiac disease, the patient does not follow a strict gluten-free diet (or the disease is not diagnosed quickly enough), more serious complications may occur. Belong to them:

  • short stature
  • weight deficiency
  • skeletal disorders (mainly related to chronic calcium deficiency and vitamin D deficiency)

Similar problems may arise in the development of permanent dentition. In addition to vitamin and mineral deficiencies, there is also a protein deficiency.

Another disorder is the delay in puberty, which may result in later fertility problems.

Patients with untreated celiac disease are also at increased risk of developing lymphoma in the small intestine.

Atypical form of celiac disease

Patients with atypical celiac disease usually do not experience standard bowel complaints. Their symptoms may appear to be unrelated to the disease. Belong to them:

  • chronic anemia
  • osteoporosis
  • arthritis
  • infertility
  • chronic fatigue
  • neurological disorders (e.g. migraine)
  • psychiatric disorders (e.g. depression)

The atypical course of celiac disease may coexist with other autoimmune diseases, including such as:

  • type I diabetes
  • rheumatoid arthritis
  • lupus
  • autoimmune Hashimoto's thyroiditis

Importantly, despite the presence of symptoms from outside the digestive system, patients meet the classic criteria for the diagnosis of celiac disease (a characteristic image of the small intestine and the presence of specific antibodies).

Late-manifesting celiac disease

The late-onset symptom onset is usually associated with an additional trigger - such as infection, sudden stress, or pregnancy, for example.

A special variant of the disease, characteristic of this particular form, is the so-called Duhring's disease, or dermatitis herpetiformis. Skin lesions of the nature of lumps and vesicles can occur in virtually all locations - on the limbs, trunk and scalp.

Usually, the diagnosis is made on the basis of microscopic examination of a section of the skin. A typical histopathological picture is an indication for the examination of a section of the intestine, which usually reveals changes typical of celiac disease. The skin lesions in Duhring's disease resolve once gluten is removed from the diet.

Important

Do you have celiac disease? Read label

Gluten is found in those foods that contain wheat, rye, barley or oats. It's not easy to eliminate it from your diet, because food producers add grains to almost everything. So read labels carefully when shopping.

  • Avoid bread, groats, pasta, cakes, cookies, flour-seasoned soups and sauces, grain coffee, beer (made from barley and wheat), and rye vodka.
  • If the product contains vegetable proteins, modified starch, check which plant these substances come from. It is similar with malt (only corn is gluten-free) and vegetable gum (no gluten, cellulose, arabic, guar, xanthan, carob).
  • Gluten can be found in low-fat dairy products, cheese, cold cuts, mayonnaise, fruit stuffing, puddings, ice cream, chewing gum, crisps, bouillon cubes.
  • It is also found in some medications (e.g. vitamins, cough syrups) and even lipsticks.

Diagnosis of celiac disease

The diagnosis of celiac disease is based on the positive results of several types of tests. The first step is usually serological testing, which measures blood levels for antibodies that are characteristic of celiac disease. There are three types of antibodies:

  • against tissue transglutaminase (TG2)
  • against endomysium (EMA)
  • against deaminated gliadin peptides (DGP)

A positive result of these tests is not sufficient to diagnose celiac disease. However, it is an indication for further diagnostics, i.e. taking samples of the mucosa of the small intestine. Importantly, before testing antibodies, make sure you are following a "normal" diet that contains gluten. If it was eliminated from the diet sooner, the antibodies may not be present in the blood.

Some confirmation of celiac disease can be obtained by microscopic examination of a specimen of the intestinal mucosa. Typically, material from the duodenum, the first segment of the small intestine, is assessed. The samples are taken with special forceps during endoscopic examination.

A typical picture of celiac disease is smoothing the structure of the intestinal mucosa and the presence of cells of the immune system - lymphocytes. The degree of advancement of the changes is described on the five-point Marsh scale. The biopsy, as well as the determination of antibodies, should take place while the patient is on a diet containing gluten.

Genetic testing for celiac disease is an additional diagnostic option. A negative test result allows you to exclude the disease with a high probability. However, a positive result is not a diagnostic criterion - it only proves the existence of a genetic predisposition, but does not confirm the existence of the disease. Therefore, it is an indication for additional tests. Genetic testing, unlike serological tests and biopsy, is not dependent on the presence of gluten in the diet. Therefore, they can also be performed when the patient started to follow a gluten-free diet on his own.

The question remains: in which people is the diagnosis for celiac disease indicated?

These are certainly patients with:

  • symptoms of malabsorption
  • gastrointestinal complaints
  • unexplained anemia

In the case of children, shortage of growth is also an indication for tests. The risk of celiac disease is increased in people whose closest relatives have a confirmed disease. Patients with other autoimmune diseases are also screened for celiac disease (that is, testing for antibodies in the blood). Some genetic conditions (such as Down's syndrome) also have an increased risk of celiac disease.

Non-celiac gluten sensitivity

In the context of diseases caused by gluten consumption, it is also worth mentioning a relatively "new" disease entity - non-celiac gluten hypersensitivity. Its symptoms may resemble celiac disease, and are often accompanied by malaise and chronic fatigue. However, after testing for celiac disease, it turns out that the results of both the antibody test and the small intestine biopsy are negative.

On the other hand, the use of a gluten-free diet brings about a very quick improvement in clinical condition and well-being. The causes of non-celiac gluten sensitivity are not fully understood. The disease is diagnosed after the exclusion of celiac disease and allergy to wheat-containing products.

Treatment is to avoid gluten in your diet. Unfortunately, no credible scientific research has yet been conducted to determine whether such a diet must be followed for life.

Celiac disease prevention

In the light of the available scientific evidence, the way to effectively reduce the risk of developing celiac disease is the early introduction of gluten-containing products into the diet of infants.

Currently, it is believed that contact with a small amount of gluten is advisable already around 5-6 months of a child's life (a small amount of porridge once a day).

After this time, you can gradually increase its amount in the diet, of course, constantly watching the reaction of the child's body. If no disturbing symptoms appear, there are no indications for limiting gluten in his diet.

Celiac disease - therapy and prognosis

The cornerstone of celiac disease treatment is the strict elimination of gluten from the diet throughout life. A few weeks after introducing a gluten-free diet, the mucosa of the small intestine heals. The antibodies typical of celiac disease also disappear after a few months.

At diagnosis of celiac disease, patients are usually referred to dietary clinics, where they learn what products they must avoid and what is the best way to replace them. It is very important to ensure the correct balance of the diet with supplementation of ingredients that are normally obtained from products containing gluten - incl. fiber and B vitamins.

The prognosis for curing celiac disease is unfavorable - it is a disease "for life". However, by strictly following a gluten-free diet, you can control the course of the disease and live a normal life.

Patients should remain under medical supervision, primarily in order to control compliance with dietary recommendations and to assess possible nutritional deficiencies and their complications. Deviations from the diet in the case of celiac disease are not recommended - eating even one meal containing gluten may cause the symptoms to recur.

 

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