Celiac Disease

Celiac disease or celiac sprue is a chronic digestive system disease. It appears in genetically predisposed people and consists of an intolerance to gluten. Gluten is a protein present in many cereals such as wheat, barley, rye, and oats. This intolerance is permanent and continues throughout life. Contact with this protein causes severe damage to the mucosa of the small intestine that manifests itself as atrophy of the intestinal villi. This causes an inadequate absorption of nutrients (proteins, fats, carbohydrates, vitamins and mineral salts).

It's about the chronic intestinal disease more frequent in Spain. It can appear both in children and adults.

How it is produced

Celiac disease is the result of the combination of genetic and immunological factors. There is a genetic predisposition in certain people for whom exposure to gluten triggers celiac disease. Gluten intake triggers a autoimmune response with appearance of specific antibodies. The wall of the small intestine is covered by intestinal villi, that is, small finger-shaped extensions that increase its absorption area. The ingestion of gluten produces an inflammation and injury of these villi, thus preventing the correct absorption of nutrients.

Symptoms

There are ways asymptomatic of the disease that can run silently for years.

The time that passes from the first contact with gluten and the appearance of symptoms varies between patient and patient. Also, celiac disease symptoms and timing can vary significantly from person to person. Thus, there are early forms that begin in childhood with symptoms before 9 months of age after introducing gluten. Other later forms appear in children older than two years or in adulthood. People without symptoms are at risk of complications from the disease so they must be treated anyway. Among the list of most frequent symptoms include:

• Chronic diarrhea, pain, and bloating.
• Weightloss.
• .
• Stopping the weight and growth curve in children and infants.
• Vomiting
• Lack of appetite.
• Anemia.
• Irritability.
• Loss of muscle mass.

Due to the lack of nutrients due to the malabsorption caused by the atrophy of the villi, other derived symptoms may appear such as: growth disorders and rickets, spontaneous fractures, skin eruptions, arthritis, sterility, osteoporosis, anemia, hair loss, alterations menstrual and muscle cramps, anxiety and depression, among others.

On the other hand, there are a number of associated diseases, that is, they occur more frequently than expected in patients with celiac disease such as dermatitis herpetiformis, liver diseases, Down syndrome, lactose intolerance and autoimmune diseases with type I diabetes mellitus, vitiligo, psoriasis or thyroid diseases.

The most serious complications associated if the disease is not treated are the appearance of cancers in the digestive tract and hematologic cancers (lymphomas), in addition to diseases derived from nutritional deficits such as osteoporosis.

Diagnosis

The definitive diagnostic test is the intestinal biopsy. Consists in take a tissue sample from the small intestine, where the absence of intestinal villi will be observed under the microscope. This test must always be carried out without eliminating gluten from the diet.

There are also a series of blood markers (antibodies) Indicative of the disease when elevated: antigliadin, antiendomysium and antitransglutaminase. They are indicated when there is suspicion of disease, if they are positive, an intestinal biopsy is carried out.

In the blood test you can find anemia and alterations of some metabolic parameters indicative of nutritional deficit. There are also genetic blood tests to help determine who may be at risk for celiac disease.

Treatment

There is no pharmacological treatment. The only treatment is total suppression of gluten in the diet. This leads to clinical recovery and normalization of intestinal tissue, generally in adults at two years of age and in children one year after dietary treatment. The diet must be followed during all life. Taking even small amounts of gluten should be avoided as they can be equally harmful and cause significant disturbances. It should be based on natural and fresh foods that do not contain it: milk, meat, fish, eggs, fruit, vegetables, legumes and gluten-free cereals (corn, rice, millet and sorghum).

Currently there is a wide range of special gluten-free products that include cereal flours, pasta, pastries, cookies, etc. but they have the disadvantage of a high economic cost. Gluten is widely used in the food industry since it is used to convey preservatives, flavorings and different food additives, so it can be contained in foods that normally do not contain it. All patients diagnosed with celiac disease should contact Celiac Associations to be properly informed of the «List of gluten-free foods». As a general rule, if a product is suspected of containing gluten, it should not be consumed.

In those cases where it is necessary, for nutritional deficits detected, vitamin and mineral supplements should be indicated to correct them. The advice of nutrition experts is recommended, since the gluten-free diet must be integrated into a healthy and balanced diet adapted to the individual needs of each patient.

Prevention

Since the exact cause is unknown, there are no measures of prevention to avoid celiac disease. However, knowing the risk factors (such as having a family member who suffers from this disorder) can allow an early diagnosis and thus an appropriate treatment as soon as possible.

Patient Associations:

• Federation of Celiac Associations of Spain
• Other associations belonging to FACE
• Celiac Association of Madrid
• Celiacs of Catalonia
• Association of European Celiac Societies (AOECS)
• Celiac Sprue Association
• Young Celiacs of Europe