Coeliac Disease

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. 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 past 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, extraintestinal 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);
•    A rise in the abdomen's size.
 

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? Of the common food  rice, millet, and corn are used for food. It is safe to use sago, quinoa. Flour made from potatoes, tapioca, sweet potato and monoca is allowed. From legumes, you can eat beans, soybeans and peas. It is permissible to eat a variety of nuts, eggs, meat, fish, dairy products, fruits and vegetables.
Medication treatment:  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 ( primadophilus or linex ). 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 amount 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 in case of 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.

Useful info

Classification and stages of development of celiac disease:
In accordance with the clinical picture and the predominance of intestinal symptoms in it, typical of gluten intolerance, two main forms of the disease are distinguished:
•    Typical celiac disease:  The classic picture is typical for pediatric patients. They have diarrhea, vomiting, abdominal pain, an increase in its volume, lag in growth and weight.

•    Atypical celiac disease: This form of the disease occurs most often. It is more difficult to diagnose, because intestinal symptoms in this case are either absent or very mild. Manifestations of atypical celiac disease include: anemia, osteoporosis , delayed physical development, neurological symptoms. Adults may be infertile.
Just like in any disease, celiac disease is distinguished by periods of the disease depending on the activity of the process:
•    Latent - a latent period when the patient does not yet have clinical manifestations. For each person, this period lasts differently: from several months to several years. Its duration depends on the characteristics of the body, and not on the amount of gluten-containing food that enters the body.

•    Active - the period of clinical manifestations of the disease.

•    The period of incomplete remission is the period of the beginning of remission. It occurs when a diagnosis is made, the cause of the disease is determined, and a strict diet is observed that completely excludes gluten-containing foods from the diet. Typically, this procedure takes three to six months. While digestive problems develop less frequently, overall health improves at the same time (albeit the symptoms do not totally go away). 

•    The period of complete remission is a period of significant weakening or complete disappearance of signs of celiac disease. It can occur only after 1-1.5 years of a strict diet that completely excludes gluten-containing foods. Since gluten no longer enters the body, the immune system does not produce new specific antibodies and complexes. Over time, the structure of the mucous membrane of the small intestine is restored, the absorption of nutrients improves. The child begins to gain in height and weight.
•    Decompensation is the period of resumption of symptoms of celiac disease. It can occur both due to not identifying the cause of the disease, or due to the negligence of the patient or his parents who do not want to heed the recommendation to exclude foods containing gluten from the diet. This can cause premature death of the patient.
Complications:
Complications of celiac disease most often develop in adults with atypical celiac disease many years after the onset of the disease. These include:
•    Skin changes: dermatitis herpiformis and atopic dermatitis, vitiligo , alopecia, aphthous stomatitis , cheilitis .

•    The risk of oncology of the gastrointestinal tract is the main cause of death in 10-50% of patients with celiac disease. Moreover, not only people with gluten intolerance are predisposed to the development of small intestine cancer, but also their closest relatives: mothers, fathers, brothers and sisters.

•    Multiple chronic ulcers in the small intestine - accompanied by fever, rapid weight loss, diarrhea, pain in the abdomen. Ulcers can be complicated, with manifestations of bleeding and scarring, which can eventually lead to intestinal obstruction - an acute surgical pathology that requires emergency care.

•    Dynamic intestinal obstruction is a disease in which the normal contractile movements of the intestinal wall are temporarily stopped. It, unlike the acute form, can do without surgical intervention. Patients with this complication experience nausea, vomiting, constipation, and abdominal pain.

•    Refractory celiac disease is persistent damage to the small intestine with characteristic symptoms despite following a strict gluten-free diet. The condition cannot be treated in this form. Its developmental process is not well known. 

•    Secondary osteoporosis is a chronic bone disease. Most often it develops in postmenopausal women after 10 years, sometimes occurs in preschool children and young people. In celiac disease, along with other nutrients, important elements for bone growth, such as calcium and vitamin d, do not enter and are not absorbed into the body. Due to their chronic lack, bone tissue cannot replenish its reserves, which leads to a decrease in its density, i.e. To bone fragility.

•    Infertility often occurs in adult patients without an obvious intestinal clinical picture, i.e. With an atypical form of celiac disease. It has also been linked to malabsorption of vital nutrients for a normal pregnancy: folic acid, iron, vitamin d, and calcium. If the diet is followed, the mucous membrane is restored and the necessary components are absorbed. Without confirmation of celiac disease, a gluten-free diet is not necessary.

•    Epilepsy is common in patients with celiac disease, and vice versa. They are also connected by insufficient intake of nutrients, or rather a deficiency of folic acid, which causes calcium deposits to appear in the substance of the brain. If children with identified epilepsy have mild manifestations of celiac disease, then treatment of epilepsy without treatment for celiac disease will be ineffective.