VERIFIED CONTENTAuthor: Krzysztof Bialazite

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 only a diet?

Celiac disease , i.e.celiac disease , belongs to the group of autoimmune diseases, i.e. 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 immune system is directed is the small intestine.

Celiac disease usually manifests itself in childhood. But it can also appear only 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 at all 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 that time.

The causes and mechanism of the development of celiac disease

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

The consumption of gluten - a mixture of proteins found in wheat, rye, barley and their derivatives - triggers their immune system stimulation by producing a variety of 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.

Typicallythere is a disappearance of the villi , i.e. the natural folds of the mucosa. In addition, the activity of digestive enzymes is reduced. These changes result indisrupting the processdigestionfoods andabsorptionnutrients.

Characters of celiac disease. Symptoms and course of the disease

Celiac disease can takeseveral clinical forms , causingdifferent types of symptoms . A typical course of the disease is associated primarily with the disturbances in intestinal malabsorption and their consequences.

A much bigger diagnostic challenge arelatent and unusual forms of celiac disease , in which it happens that for many years it is impossible to make a correct diagnosis.

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

  • classic celiac character

The classic form most oftenis revealed 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 pains
  • flatulence
  • chronic diarrhea

Inadequate absorption of nutrients may 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 celiac character

If, despite the diagnosis of celiac disease, the patient does not follow a strictgluten-free diet(or the disease is not diagnosed quickly enough), more serious complications may occur. These include:

  • low rise
  • 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 aprotein deficiency .

Another disorder is delayed puberty, which may result in later fertility disorders.

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

  • unusual celiac character

Patients with atypical celiac disease usually do not experience standard bowel discomfort. Their symptoms may appear to be unrelated to the disease. These include:

  • 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
  • Hashimoto autoimmune 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-revealing celiac disease

Late-onset symptoms onset are usually associatedwith an additional trigger- such asinfection, sudden stress or pregnancy .

A special variant of the disease, characteristic of this particular form, is the so-calledDuhring'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.

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

We recommend

Author: Time S.A

An individually selected diet will allow you to easily eliminate gluten from the menu, and at the same time eat he althy, tasty and without sacrifices. Take advantage of JeszCoLisz, an innovative online dietary system from the He alth Guide and take care of your he alth and well-being. Enjoy the perfectly selected menu and the constant support of a dietitian today!

Find out moreImportant

Do you have celiac disease? Read labels

Gluten is found in those foods that contain wheat, rye, barley or oats. It is not easy to eliminate it from the 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 or modified starch, check which plant these substances come from. The same is true with m alt (only corn is gluten-free) and vegetable gum (no gluten, cellulose, arabic, guar, xanthan, locust bean gum).
  • Gluten can be found in low dairy productsfat content, cheese, cold cuts, mayonnaise, fruit stuffings, puddings, ice cream, chewing gums, crisps, bouillon cubes.
  • It is also found in some medications (e.g. vitamins, cough syrups) and even lipsticks.

Celiac diagnosis

The diagnosis of celiac diseaseis based on positive results from several types of tests. The first step is usuallyserological tests , which test the blood for antibodies specific to 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 testsis 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, make sure you are following a "normal" diet that contains gluten before testing for antibodies. If it was eliminated from the diet, the antibodies may not be present in the blood.

Certain confirmation of celiac diseasecan be obtained by microscopic examination of a section 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 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.

An additional diagnostic option isgenetic testing for celiac disease . A negative test result allows you to exclude the disease with a high probability.A positive result does not constitute a diagnosis criterion- it only proves the existence of a genetic predisposition, but does not confirm the existence of the disease. It is therefore an indication for additional tests.Genetic testing , unlike serological testing 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 diagnosis for celiac disease indicated?

These are certainly patients with:

  • symptoms of malabsorption
  • gastrointestinal complaints
  • anemia of undetermined cause

In the case of children,shortage of growthis also an indication for testing. 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 from the blood). Some genetic conditions (e.g. Down's syndrome) also have an increased risk of developing 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. After testing for celiac disease, however, it turns out that the results of both the antibody test and the small intestine biopsy are negative.

Following a gluten-free dietbrings about a very quick improvement in your 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 allergies to wheat-containing products.

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

Celiac disease prevention

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

Currently, it is believed that contact with a small amount of gluten is recommendedfrom around 5-6 months of the 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 there are no disturbing symptoms, there are no indications for limiting gluten in his diet.

Celiac disease - therapy and prognosis

The basis of treatment for celiac disease isstrict 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 which products to avoid and what are the best substitutes for them. It is very important to take care of ito the correct balance of the diet with the addition 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 dietin celiac diseasenot recommended- eating even one meal containing gluten may cause the symptoms to recur.

About the authorKrzysztof BialaziteA medical student at Collegium Medicum in Krakow, slowly entering the world of constant challenges of the doctor's work. She is particularly interested in gynecology and obstetrics, paediatrics and lifestyle medicine. A lover of foreign languages, travel and mountain hiking.

Read more articles by this author

Category:

Gastrology