What happens in the intestines
Gluten is not partially broken down in the intestines. In people with certain genes (HLA-DQ2 and DQ8), its fragments cause an immune reaction, and the body begins to produce antibodies, including to its own enzyme - tissue transglutaminase. Inflammation occurs, the villi of the small intestine are shortened and flattened. The absorption surface is reduced many times, and the absorption of iron, calcium, folic acid, vitamins and fats is impaired.
- Typical form - with diarrhea and signs of impaired absorption
- Atypical - anemia, osteoporosis, infertility, skin lesions
- Asymptomatic - detected during examination of relatives
- Dermatitis herpetiformis is a skin manifestation of celiac disease.
Causes and risk factors
To develop celiac disease, a genetic predisposition and gluten consumption are required. The disease is more common in close relatives of patients and in other autoimmune diseases. Celiac disease should not be confused with wheat allergy and non-celiac gluten sensitivity - the mechanism and consequences are different for them.
- Celiac disease in parents, brothers, sisters, children
- Diabetes mellitus type 1
- Autoimmune thyroiditis
- Down and Turner syndromes
- Immunoglobulin A deficiency
Symptoms
The manifestations are very diverse, so celiac disease is not recognized for a long time. In adults, intestinal symptoms may be absent, and the consequences of deficiency of substances come to the fore.
- Chronic diarrhea, large fatty stools, bloating
- Weight loss, in children - stunted height and weight
- Iron deficiency anemia that cannot be treated
- Chronic fatigue, mouth ulcers
- Osteoporosis, bone pain
- Menstrual disorders and infertility
- Itchy blistering rash on elbows and knees
Diagnostics
The first stage is a blood test for IgA antibodies to tissue transglutaminase along with total IgA, since if it is deficient, the result will be false negative. If the test is positive, gastroscopy with a biopsy from the duodenum is performed in adults. It is extremely important that all studies are conducted while the person is eating gluten. If you switch to a diet in advance, tests and biopsies may normalize and the diagnosis cannot be confirmed.
- IgA antibodies to tissue transglutaminase
- Total immunoglobulin A
- Antibodies to endomysium or deamidated gliadin peptides as indicated
- Gastroscopy with duodenal biopsy
- Complete blood count, iron, ferritin, vitamin D, calcium, densitometry
Treatment and life with celiac disease
Treatment is a strict lifelong gluten-free diet. Wheat, rye, barley and products made from them are excluded from the diet, as well as dishes where gluten is added hidden: sausages, sauces, semi-finished products, some sweets. Rice, buckwheat, corn, potatoes, meat, fish, eggs, dairy products, vegetables and fruits are allowed. Oats are only acceptable if they are certified gluten-free and if they are well tolerated. The first months correct deficiencies of iron, calcium, vitamin D and folic acid. Antibody monitoring and consultation with a gastroenterologist help ensure that the diet is being followed correctly.
- Read the ingredients of products carefully
- Use a separate cutting board and toaster
- Warn about diet in cafes and schools
- Examine close relatives
- Periodically check antibodies, blood tests and bone density