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Celiac Disease
Overview
Definition of disease.
Celiac disease (gluten intolerance) is a chronic genetic disease in which foods containing gluten (pastries, pasta, breakfast cereals and yogurt) damage the lining of the small intestine, where most of the absorption of nutrients occurs. With celiac disease, the body does not receive proteins, fats, carbohydrates and vitamins in full, which leads to weight loss
The main cause of celiac disease is gluten - a protein component of cereals: wheat, rye, barley. It, like gluten, binds together the proteins of these cereals.
Gluten intolerance develops only in people with a genetic breakdown in the immune system. In such cases, products with this component are perceived by the body as an allergen, a "foreign" agent. It leads to the activation of the immune response, which contributes to damage to the intestinal villi. This leads to a decrease in nutrient absorption, which causes a person with gluten intolerance to not only lose weight, but also develop many other diseases that mask the underlying problem.
If a person has celiac disease, then with a probability of 20% this disease can be diagnosed in his relatives. Much more often, celiac disease is detected among twins - in 86% of cases.
What products may contain gluten:
• In products made from wheat flour: bread, pasta, pastries;
• In products containing rye, oats, and barley.
Given its widespread use as a "thickener", gluten also contains:
• Sweets;
• Yogurts;
• Ice cream;
• Canned food;
• Beer;
• Thick sauces;
• Breakfast cereals, excluding real corn flakes.
Since gluten is included in many foods, it inevitably enters the body with food. Exactly how much celiac disease will develop in predisposed people has not yet been established - each case is individual. How serious the manifestations of the disease will be depends primarily on the activity of the autoimmune process.
Symptoms
The clinical picture of celiac disease is so diverse that there is no single symptom that would occur in 100% of patients.
Most often, the first signs of the disease occur in children 1.5-2 months after the introduction of complementary foods (flour products and multi-cereal cereals). The child's appetite decreases until he refuses to eat. There may be bouts of vomiting and problems with the stool - it becomes plentiful, frothy, greasy and fetid. The child lags behind his peers in weight, grows poorly, which indicates a delay in physical development [2] . Parents note that the child has increased irritability, sleep disturbance, sometimes apathy and a decrease in mood. In the case of apathy, the child is practically not interested in the outside world, unlike other healthy children. Sometimes there may be hypotension - weakness of the muscles. At the same time, the child loses the acquired skills: if earlier he knew how to get up and walk on his own, then later time stops doing it. In addition, food allergies to cow's milk proteins and lactose deficiency may appear
Sometimes all these symptoms reappear after previous infections: intestinal flu (rotavirus infection) or respiratory diseases. Any infection activates the immune system to fight viruses and germs. With celiac disease, this immune response will be wrong: it will be directed not only to the destruction of viruses, but also to the damage to the mucous membrane of the small intestine.
Older children complain of abdominal pain, which is intermittent, but localized - they occur in the umbilical region. In adolescents and adults, extra intestinal manifestations predominate. The clinical picture of celiac disease becomes blurred, which greatly complicates the correct diagnosis. Therefore, the patient can be observed for years for other diseases that are actually the result of gluten intolerance
In general, there are several specific symptoms that a paediatrician may suspect of having gluten intolerance:
• Abdominal pain (with the exclusion of surgical pathology);
• Copious, offensive, frothy, greasy stools;
• Vomiting (rare to daily);
• An increase in abdominal circumference.
Prevention
There are currently no specific measures for the prevention of celiac disease aimed at preventing the appearance of its cause.
With strict adherence to the diet, the complete rejection of gluten-containing products, the prognosis is favourable. Following dietary recommendations reduces the risk of developing gastrointestinal cancer. If the patient, despite a long-term diet, has intestinal disorders, then he needs to repeat a biopsy of the small intestine to exclude oncology.
Patients with refractory celiac disease who are not amenable to dietary therapy should be more carefully examined for the presence of oncological diseases.
Treatment
Since the cause of this disease is gluten-containing products, it is necessary not only to limit their consumption, but to completely eliminate them. The disease cannot be eliminated completely, you can only support the body, so the diet must be followed constantly.
The diet is compiled by a nutritionist who treats gluten intolerance. If specific antibodies are detected, but there are no clinical manifestations, then a diet for celiac disease is not prescribed - only observation in dynamics is shown.
What can patients with celiac disease eat?
Rice, millet, and corn are used for food. It is safe to use sago, quinoa. Potatoes and sweet potato is allowed. From legumes, you can eat beans, soybeans and peas. It is permissible to eat various nuts, eggs, meat, fish, dairy products, fruits and vegetables.
The question of the safety of eating oats is still open. It is quite rare in its pure form: it contains impurities of wheat. This makes the product unsafe for gluten intolerance
Medication:
Treatment for celiac disease can be a life-saving measure. It is aimed at filling the deficiency of vitamins and minerals. If necessary, the restoration of the intestinal microflora is carried out - the appointment of lactose-free probiotics. With iron deficiency and the development of iron deficiency anemia, preparations containing iron and folic acid are indicated, which the body needs to improve the absorption of iron. With calcium deficiency, osteoporosis and the appearance of seizures, calcium and vitamin D are prescribed.
In severe advanced cases, when the patient cannot eat or his body cannot absorb food naturally, intravenous infusion of nutrients is acceptable.
Tests Required for Diagnosis
Diagnosis is carried out if celiac disease and associated diseases are suspected, for example, growth retardation, type 1 diabetes mellitus, etc. It is very important to take tests before starting a gluten-free diet, i.e. against the background of the usual diet in which symptoms appeared. If the diet is followed, the number of specific antibodies decreases, which can lead to false negative results. This will make it difficult to make a correct diagnosis.
During the initial examination, the overall level of immunoglobulin A is determined. When passing a biochemical analysis, one should pay attention to anemia, a decrease in the level of albumin, calcium, potassium, sodium, an increase in the level of alkaline phosphatase and an increase in blood clotting time.
There is also an analysis for specific antibodies that are formed by immunity with gluten intolerance:
• To tissue transglutaminase;
• To deamidated gliadin peptides;
• To the endomysium.
Most often, if gluten intolerance is suspected, blood is taken from a vein to determine antibodies to tissue transglutaminase, and only then is the issue of EFGDS (esophagogastroduodenofibroscopy) performed with a biopsy of the small intestine villi. A biopsy is needed in order to look at intestinal cells under a microscope and determine the level of damage to the villi. If the bowel biopsy fails and the villi remain normal, but there is a positive blood test for specific antibodies, then the presence of celiac disease cannot be ruled out
