Celiac disease is a lifelong disease that requires lifelong intake of gluten-free food, which means that the diet should permanently exclude all kinds of products that have traces of flour made from wheat, barley, oats and rye. Compliance with gluten-free diet leads to a complete recovery, and every crumb of bread would cause recurrence.
Celiac disease is a chronic disease of the small intestine that is caused by a permanent intolerance to gluten. It is also called gluten-sensitive enteropathy. Immune reactions (allergy to gluten) results in permanent damage to the intestinal villi, which lose their primary function - absorption of nutrients from food.
This disease is researched by gastroenterologists (disease affects the small intestine), immunologists (intense local allergic reaction and the appearance of antibodies in the blood) and geneticists (it affects just genetically predisposed persons). The disease is more common among relatives, in areas where the diet is based on grains containing gluten. Most often, the first symptoms occur in the second year of life, although the onset is sometimes gradual, with the appearance of symptoms in adulthood.
Causes and symptoms
Gluten is a complex protein that comes from some grains (wheat, barley, oats and rye). In people who are genetically prone to this allergy the immune response that damages the intestinal villi starts at the end of the first year of life, when the daily diet contains some of these grains. Villi form the curled wall of the small intestine with a special epithelium of the enormous absorbent power and surface. Damage to the intestinal villi permanently changes normal appearance and function of the small intestine – there is no absorption of nutrients and the body begins to suffer. The child initially eats normally, but keeps getting thinner, and it eventually loses the appetite.
Lack of fat and carbohydrates will affect the growth and cause the loss of subcutaneous fat. Loss of protein will reduce muscle mass, a lack of vitamins and minerals will cause anemia, poor quality of skin, hair, behavior disorders ... Watery stools with profuse vomiting can lead to a collapse of circulation, which seriously threatens the life of a person (celiac crisis).
Clinical picture usually appears at the end of the first year. The first symptoms are loss of appetite, lack of progress, less frequent stools, occasional vomiting. Over time, diarrhea becomes more frequent, stools become watery and foamy.
Due to the weakened muscles child gets tired quickly and loses the interest, and the abdominal wall becomes thin and tense. The body acquires characteristic appearance (skinny child with a big belly). The child becomes moody, irritable, without appetite and expected progression in psychomotor development. The hair is thin, brittle. The blood count is characteristic of anemia and low protein, and the stool contains increased amount of unabsorbed fat and protein. Over time, the stools become rarer and the health deteriorates.
Atypical forms of the disease are manifested in late childhood as short stature, anemia that does not respond to conventional treatment and occasional stomach problems. Late puberty, recurrent abdominal pain, disorders of enamel, recurrent aphthous stomatitis, changes in appetite and behavior - atypical symptoms that should arouse suspicion that it may be an atypical form of the disease.
There are people who have no symptoms, and genetic predisposition can be proved. It is believed that the typical form of celiac disease is a tip of the iceberg - on one patient with the typical form of the disease there are ten with non-manifested form. Any person who has a genetic predisposition or has atypical symptoms should do the tests and be under the supervision of a specialist to determine the hygienic-dietary regime and the necessary treatment.
Diagnosis is based on clinical picture, genetic tests, biopsies of the small intestine and laboratory analysis. The gold standard for diagnosis is proving the existence of the atrophy of intestinal villi on histopathologic specimen taken during biopsy.
There are several types of antibodies found in the blood - their occurrence confirms the existence of allergy to proteins from those grains. Anemia, low levels of vitamins and protein in blood confirm the diagnosis. Diagnostic procedures are not performed fast and are not pleasant, but they are necessary in order to reveal the true nature of the disease. The appearance of the intestinal villi and the level of antibodies in the blood are monitored by the criteria of modern gastroenterological practice.
Treatment is initiated immediately after diagnosis. Celiac disease is a lifelong disease and requires lifelong treatment with gluten-free food. Compliance with gluten-free diet leads to a full recovery, and the smallest crumb of bread would cause a recurrence. This is a real example that the food sometimes can be a poison and a medicine.
In the acute stage of the disease one must take enough water, minerals and vitamins. After the establishment of the function of the small intestine, anemia is treated by administration of iron and folic acid.
The very basis of this special diet consists of rice and corn that do not contain gluten. A particular problem is the so-called hidden gluten, which usually is not listed on the label or gets into the dough during production (surface is often in contact with prohibited types of flour in mills and furnaces). For this reason one should use products that are labeled "gluten-free" by the trusted manufacturers.
The diagnosis of celiac disease always brings changes and involvement of the whole family. After a child is diagnosed, the full commitment of other family members is required in the acquisition and preparation of food. The child should be taught to comply with the diet. Older patients are aware of the seriousness of the situation, happy to accept a change in diet. Certainly, the more time and patience is necessary to explain to a child why his /her menu is always different from the menu of the peers and why is his/her birthday cake special.
Of course, with proper treatment and strict adherence to not consuming gluten, a full recovery is likely. The child will overcome growth and psychomotor development problems, and will become capable to perform all activities. It is known that some top athletes owe their good health to early diagnosis and proper gluten-free diet.