Celiac disease What we need to know

25.10.2022

Celiac disease is a chronic autoimmune disease with inflammation of the mucous membrane of the small intestine, which occurs in people who are sensitive to gluten, a protein found in cereal crops (wheat, rye and barley). The disease is determined by the genetic disposition. If a person has celiac disease, in one out of ten cases it will also be found in their first-degree relatives (mother, father, child, sister, brother).

Table of Contents

Celiac disease can develop both in childhood and in adulthood. It is quite common - 1-2 cases per XNUMX people, but it is estimated that eight out of ten cases of celiac disease remain undiagnosed.

What is the mechanism of disease development?

Eating a product containing gluten causes an immune response in the body of a person with celiac disease. The immune reaction takes place in the small intestine and causes its inflammation. As a result, the intestinal folds are damaged - growths of the intestinal mucosa, which are necessary for increasing the absorption surface area of the intestine and for adequate absorption of nutrients. Damage to the intestinal mucosa associated with malnutrition, which causes serious problems for Adam.

Epidemiology

The prevalence of the disease in the general population is from 1:40 to 1:300, in first-degree relatives of the affected person - 1:22, and in second-degree relatives - 1:39. The incidence of celiac disease among insulin-dependent diabetics is 20 times higher than in the general population and is 3-10% in children and 2-5% in adults.

In 60% of patients, celiac disease is diagnosed immediately after diabetes is detected, and in 40% - later. Undiagnosed and untreated celiac disease makes diabetes management difficult.

Symptoms

Who should be tested for celiac disease? which research should start the diagnostic process?

Testing is required for:

Patients with suspected celiac disease clinical symptoms:

chronic or recurrent diarrhea of unknown etiology;
chronic eating disorders;
weight gain delay/deficit;
Growth retardation;
delayed puberty;
Amenorrhea;
Iron deficiency anemia;
nausea/vomiting;
recurrent/chronic abdominal pain;
Flatulence
chronic constipation;
Chronic fatigue;
recurrent aphthous stomatitis;
Herpetiform dermatitis;
osteopenia (fractures with minimal trauma) or osteoporosis;
changes in liver function tests;

Risk factors

Celiac disease is more common in people who have:

type 1 diabetes;
Down syndrome or Turner syndrome;
autoimmune thyroid disease;
microscopic colitis (lymphocytic or collagenous colitis);
Addison's disease;
Williams syndrome;
selective IgA deficiency;
autoimmune liver damage;

The initial test for IgA-competent patients is the determination of IgA-class antibodies against tissue transglutaminase, and in individuals with low levels of IgA (total IgA).

in children

Children with celiac disease are more likely to have digestive problems, including:

Nausea and vomiting;
Chronic diarrhea;
Bloated tummy;
Constipation.

Complications

Untreated celiac disease can cause:

Malnutrition – This happens when your small intestine can't absorb enough nutrients. Malnutrition can cause anemia and weight loss. Malnutrition in children can cause slow growth and short stature.
Weakened bones – malabsorption of calcium and vitamin D can cause softening of the bones (osteomalacia or rickets) in children and loss of bone density (osteopenia or osteoporosis) in adults.
Infertility and miscarriage – malabsorption of calcium and vitamin D contributes to reproductive problems.
Lactose intolerance – damage to the small intestine can cause abdominal pain and diarrhea after consuming lactose-containing dairy products.
Cancer – People with celiac disease who do not follow a gluten-free diet are at increased risk of developing several forms of cancer, including intestinal lymphoma and small bowel cancer.

Two types of celiac disease:

The World Organization of Gastroenterologists distinguishes between two forms of celiac disease: classic and non-classic.

Classic celiac disease presents with a malabsorption syndrome that includes diarrhea, steatorrhea (thick, greasy stools), weight loss in adults, or growth retardation in children.

In the case of non-classical celiac disease, mild gastroenterological symptoms are expected without severe clinical signs of malabsorption or completely different types of symptoms, which we have listed above.

Sometimes celiac disease is asymptomatic. The patient does not complain about anything, although he has pronounced atrophy of the small intestine. gluten-free diet In this case, it will have a positive effect on his health. Thanks to the diet, people feel much more energetic and healthy.

Diagnosis

In the case of positive responses to serological testing, the diagnostics of celiac disease is confirmed by histomorphological analysis of the biopsy material of the small intestine.

Genetic research (HLA testing) is indicated in patients with non-specific clinical symptoms, negative results of serological tests and mild infiltrative changes in the biopsy material of the proximal small intestine. HLA typing is also justified in asymptomatic individuals from the risk group. If the diagnostics is confirmed, the patient is managed and monitored by a gastroenterologist. Management of celiac disease involves an agliadin or gluten-free diet. The diet continues throughout life. Against the background of a complete diet, there is a reversal of the atrophic changes of the intestine in 3-6 months, followed by resolution of gastrointestinal manifestations, acceleration of growth and improvement of bone mineralization (density). Patient surveillance includes monitoring of clinical status and serological tests. Normalization of serological tests takes 6-12 months on average.