Similar symptoms often do not mean the same disease. Complaints related to gluten intake may be related to celiac disease and non-celiac gluten intolerance (gluten sensitization).
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Celiac disease is an autoimmune disease, while gluten intolerance is a sensitization reaction to gluten. Celiac disease affects the small intestine and has a familial nature. Gluten intolerance is an allergic reaction, it is not hereditary.
In both cases, the recommendation is the same - to refrain from eating gluten. However, in the case of celiac disease, the exclusion of gluten from the diet is complete and permanent, and in the case of gluten allergy, it is possible to allow small doses of gluten-containing products in the diet after the condition improves.
Gluten intolerance (sensitization)
|It is an autoimmune genetic disease in which wheat, barley, and rye products initiate the production of autoantibodies.||Allergic hypersensitivity to products containing gluten|
|Diagnosed by detecting autoantibodies in the blood or by examining small intestine biopsy material||It is diagnosed by excluding celiac disease, by finding antibodies to gluten in the blood|
Gluten intolerance and celiac disease have practically similar symptoms. Removing gluten-containing products from the diet greatly improves the condition.
- Flatulence, bloating, constipation
- Weakness, headache, dizziness
- Diarrhea, vomiting
- Discomfort or pain in the joints
Without diagnostic tests, it is practically impossible to distinguish between these pathologies.
It is thought that exposure to amylase/trypsin inhibitors may be the cause of gluten hypersensitivity. Amylase/trypsin inhibitors are proteins that are part of grains - barley, rye, wheat.
In addition to celiac disease and gluten intolerance, wheat allergy also has similar symptoms - this is an immune reaction to the components of wheat. Eating even a minimal amount of wheat bran products can cause:
- Skin rash, hives
- Swelling of the respiratory tract
Diagnosis of celiac disease
First-line tests for celiac disease in both children and adults include determination of tissue transglutaminase IgA antibodies.
In the first stage of the study in children under 2 years of age, a study of deaminated gliadin IgA and IgG is also recommended. When diagnosing celiac disease, it is necessary to include gluten in the patient's diet (otherwise, antibodies will not be produced). Over 93% of people with celiac disease test positive for tissue transglutaminase antibodies in patients who consume gluten-containing products.
There is a possibility of a false-positive response to the tissue transglutaminase antibody test in people who have been diagnosed with other autoimmune diseases: type I diabetes, Hashimoto's thyroiditis, psoriasis,
Rheumatoid arthritis, autoimmune liver damage, as well as heart failure and more.
The IgA endomysial antibody test has nearly 100% specificity in diagnosing celiac disease, although 5-10% of celiac patients may test negative.
Determination of total serum IgA – used to rule out IgA deficiency characteristic of celiac disease, as this may give false negative results for tissue transglutaminase and endomysial immunoglobulins. Serum IgA deficiency is also found in other diseases, such as: villous atrophy (a disease with atrophy of the intestinal canals), giardiasis (a bacterial disease of the small intestine), overgrowth of the microflora of the small intestine, and others.
Deaminated Gliadin Peptide – This test is used to screen for celiac disease in patients with serum IgA deficiency and negative results for tissue transglutaminase and endomysial antibodies.
The next step in the diagnostics of celiac disease is the detection of human leukocyte antigens HLA-DQ2/DQ7/DQ8 and HLA-DR in serum. Absence of these antibodies excludes celiac disease.
In addition to laboratory methods, a biopsy of the intestinal wall and an endoscopic visualization method are used.
Diagnosis of gluten intolerance
The diagnostics of gluten intolerance usually requires the exclusion of celiac disease by instrumental laboratory methods. Gluten allergy specific IgE test is used to diagnose gluten allergy.
For both celiac disease and gluten allergy, the best treatment is to eliminate sources of gluten from the diet. This reduces inflammatory processes in the small intestine, as well as symptoms - diarrhea, abdominal pain, malabsorption and others. Treatment of symptoms and complications is aimed at elimination of pathogenic mechanisms and their need and duration is decided by the attending physician, based on clinical and laboratory data.
Avoiding gluten-containing products without medical advice does not mean a healthy diet. Taking gluten-free products means limiting fiber products in the diet, sometimes even vitamin deficiency, because gluten-free food is not enriched with vitamins or minerals.
Cereals containing gluten, within the norm, are necessary for a healthy diet, because they contain a large amount of B vitamins and iron.
When to see a doctor?
If a parent or sibling has been diagnosed with celiac disease, even in the absence of symptoms.
If you have any symptoms of celiac disease or gluten sensitivity.
In the presence of any autoimmune disease, as this increases the risk of developing other autoimmune diseases, including celiac disease.
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