Celiac disease

 

A doctor holds  a signboard with the text celiac disease written in it.Celiac disease (also spelled as coeliac disease, sometimes referred to as sprue or gluten-sensitive enteropathy) is a chronic disorder caused by the body’s unusual reaction to  gluten which results in the damage of the intestines and poor absorption in the guts (malabsorption).

Overview

Celiac disease is of autoimmune origin, meaning that the cells of the intestinal villi are damaged by the body’s own immune system and inflammatory reaction due to gluten intolerance, this protein is commonly found in wheat, rye and barley. When the mucous membranes and the cells are damaged, the villi of the small intestines become flat (villous atrophy) and the absorption of the nutrients such as vitamins, minerals and fats is decreased (malabsorption). Celiac disease has many faces, only a small proportion of individuals with celiac disease have classic symptoms, whereas a much bigger number of ill individuals have an atypical disease presentation. Furthermore, minimally active, completely asymptomatic disease (“silent celiac disease”) is observed in even greater number of persons.

Causes

Celiac disease is considered an autoimmune disorder triggered by the gluten intolerance, although the exact cause and mechanisms of the sprue haven’t been verified. It is suggested that the gluten intolerance seen in celiac disease is genetically predisposed with a strong association with human leukocyte antigen HLA-DQ2/DQ8.  therefore, those who have a first-degree relative with celiac disease are at risk of developing celiac disease at some point in their life.

The consumption of gluten, namely, the reaction with gliadin, causes the inflammatory response mediated by the immune system and, probably, serum antibodies – IgA antigliadin, antiendomysial, and anti-tTG antibodies – are also involved.inflammation of the intestinal mucosa eventually leads to its atrophy, the number of mucous cells, intestinal villi and the depth of the crypts decrease gradually causing foods maldigestion and malabsorption of the nutrients.

Risk factors

Celiac disease is often associated with other disorders, especially autoimmune diseases, such as:

Symptoms

The disease can manifest at any age, albeit the peak  The disease can manifest in infancy after weaning on to cereals – diarrhea is detected and the child fails to thrive. Growth retardation may be noticed in older kids. Pubertate may also be delayed due to malnutrition and severe nutrient deficiency.

In adults the disease typically occurs during the third or fourth decade of life. In general, symptoms of the celiac disease vary greatly and may be of various severity:

  • Chronic diarrhea or constipation;
  • Steatorrhea (pale, grayish fatty stools with a foul smell);
  • Flatulence, abdominal bloating;
  • Borborygmys;
  • Vomiting;
  • Weight loss;
  • Abdominal cramps and severe abdominal pain;
  • Paleness;
  • Fatigue;
  • Irritability;
  • Ulcers in the mouth;
  • Migraines;
  • Irritability;
  • Mood swings;

Dermatitis herpetiformis is a term used to describe the skin lesions observed in celiac disease. The characteristic itching papulovesicular rash is detected over the  extensor surfaces of the extremities and over the trunk, scalp, and neck.

Due to the nutrients malabsorption individuals with the long-lasting course of the disease, severe nutrition deficiencies occur – B12 deficient or iron deficient anemia, osteoporosis due to calcium deficiency, vitamin K deficiency leads to bleeding disorders, heavy menstrual periods and easy bruising. Of note, in older individuals symptoms of nutrient deficiency are less prominent.

  • Joint and muscle pain;
  • Muscle cramps;
  • Tingling in the legs due to nerve damage;
  • Frequent bone fractions due to osteoporosis;
  • Seizures;

Diagnosis

  • Complete blood count reveals low red blood cells count (anemia), transferritin, folate and albumin values may be decreased.
  • Detection of immunoglobulin A antiendomysial antibodies is one of the most accurate tests for diagnosing celiac disease. Additionally, antigliadin antibodies may also be quantified.
  • Biopsy of the duodenum during endoscopy is considered the gold standard for the celiac disease diagnosis – characteristic villous atrophy with decreased height of the villi and reduced crypt depth is usually observed plus increased lymphocytic infiltration of the intestinal wall.
  • Genetic testing helps to reveal the genetic predisposition to gluten intolerance and determine the disease.

Gluten-free diet

There is no cure for the disease. However, as celiac disease is caused by the gluten intolerance, gluten-free diet is helpful to reduce the disease symptoms within a few weeks after the initiation of the exclusion therapy.

The following foods should be avoided:

  • wheat flours, including durum flour, enriched flour, graham flour, semolina flour, and white flour;
  • wheat germ, wheat starch, wheat bran, cracked wheat;
  • products made with the above mentioned wheat products such as pasta, bread, cakes, cookies;
  • barley, barley flour, and products made with barley;
  • rye, rye flour, and products made with rye;
  • triticale and other wheat hybrids;
  • oats;

Plain fruits and vegetables, plain meat, potatoes, rice, products made of corn, nuts, buckwheat, beans and peas can be safely consumed.

Additionally, calcium supplementation of up to 1500 mg/day is recommended when osteoporotic changes of the bones are observed.

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