What is celiac disease?
Celiac disease, or <-sensitive enteropathya href="https://www.sns24.gov.pt/tema/doencas-gastrointestinais/doenca-celiaca/dieta-sem-gluten/" target="_blank" rel="noopener">gluten, is a chronic disease that triggers an immune reaction of inflammation of the small intestine after ingestion of gluten in the diet.
There are different forms of gluten and wheat sensitivity that are not celiac disease:
- Non-celiac gluten sensitivity: Symptoms such as abdominal pain and/or bloating, intestinal changes, among others, usually begin a few hours or days after gluten ingestion
- Wheat allergy: Symptoms begin minutes to hours after eating wheat and may include severe allergy manifestations (anaphylaxis) with difficulty breathing, coughing, swelling of the mouth and tongue
What is gluten?
The gluten is a set of proteins that is found in cereals such as wheat, barley, rye, and sometimes oats.
What are the causes of celiac disease?
Celiac disease is an autoimmune disease, whose origin can be at the intersection of three factors:
- environmental factors, for example by the amount of gluten in children's diets
- immunological disease, due to the body's inappropriate immune reaction to gluten
- Genetic
At what age do the first symptoms appear?
Celiac disease can manifest itself at any age, as long as the gluten has already been introduced into the diet.
It usually appears between 6 and 24 months of age, some time after the introduction of foods with gluten in the diet (porridge, bread, biscuits, among others).
What are the symptoms of the disease in children?
The symptoms are varied, and may involve several organs and not only the gastrointestinal tract.
In children, the most common symptoms of the disease are gastrointestinal symptoms:
- chronic diarrhoea (stools are often bulky and smelly and floating)
- constipation
- lack of appetite
- bloating
- abdominal pain
- vomiting (sometimes)
Other, less common, non-gastrointestinal symptoms may appear:
- growth retardation, insufficient weight loss or gain
- Delay of the first menstruation (menarche)
- iron deficiency anemia
- Tooth enamel changes
- joint pain
- chronic tiredness
- Skin manifestations, blistered and itchy (dermatitis herpetiformis)
- recurrent canker sores in the mouth
- change in behaviour (aggressiveness, mood swings)
- anxiety, depression, sleep problems
- recurrent headache
Can adults have other different symptoms?
In adults, this disease often presents differently and with transient gastrointestinal complaints. In addition to the symptoms described in children, they may also present:
- small red blisters on the skin (dermatitis herpetiformis, more common in adults than in children)
- hormonal changes that can alter fertility and early menopause
- vitamin and calcium deficiencies recurrent miscarriages
- premature osteoporosis
What are the complications of celiac disease?
Those who have this disease trigger a series of responses from our body's protective system (immune system) against their own intestine after ingesting gluten, which modify their inner layer of the intestinal wall (mucosa) and cause consequences, such as:
- decreased nutrient absorption
- increased risk of other diseases, such as:
- osteoporosis
- Intestinal lymphoma
What are the risk groups for this disease?
The main risk groups, for which screening may be indicated, are:
- direct family members (1st degree of kinship)
- People with:
- Diabetes mellitus (type 1)
- inflammation of the thyroid (autoimmune thyroiditis)
- chronic inflammatory disease involving the joints (juvenile idiopathic arthritis)
- inflammation in the liver that gradually damages liver cells (autoimmune liver disease)
- genetic syndromes: Down's, Turner's, Williams'
How is the diagnosis made?
Diagnosis consists of identifying symptoms that raise suspicion of the disease and is based on:
- (serological) tests to confirm the presence of antibodies (anti-gliadin, anti-transglutaminase, anti-endomysium)
- bowel biopsy, most often required to confirm the diagnosis
- genetic testing, may be useful in case of discordant results
It is not recommended to make any dietary restriction before the diagnosis is confirmed, thus avoiding inconclusive diagnoses and consequent harm to people.
What is the treatment for celiac disease?
The treatment of celiac disease involves exclusively a diet without gluten, allowing the regeneration of the intestinal mucosa. To date, there is no pharmacological treatment for this disease.
It is also essential to have a complete, varied and balanced diet that provides the body with all the necessary nutrients.
Is there any way to prevent celiac disease?
There are ways to nullify the symptoms of the disease, but not to prevent its onset.
The European Society of Paediatric Gastroenterology and Nutrition (ESPGHAN) advised that the introduction of gluten into the child's diet should not be done before the age of 4 months. Preferably, foods with gluten should be introduced up to 7-12 months and high amounts should be avoided in the first weeks after the introduction of gluten into the diet, and also in childhood.
The breastfeeding also appears to have a protective effect, and the recommendation of exclusive breastfeeding until 6 months is maintained.
Is celiac disease reversible?
Nope. However, although the disease persists, if you follow a gluten-free diet, the symptoms can be almost negligible and the gut can recover from its inflammation completely.
A person who "no longer suffers from celiac disease" may have always been a "false celiac." In most cases, there may not have been a correct diagnosis a priori.