Most often (85%) total exclusion of gluten from the diet is the restoration of the small intestine functionality in 3-6 months. Celiac disease marked characteristic villus atrophic changes in the small intestinal mucosa. The disease is more prevalent in women, they suffer them twice as often as men.
What it is?
Celiac - multifactorial disease, digestive disorder caused by damage to the villi of the small intestine certain foods, containing certain proteins - gluten (gluten) and close thereto cereal proteins (avenin, hordein, etc.) - in cereals such as wheat, rye, barley. Oats contains gluten, but due to the characteristics of processing and transportation process may contain traces of wheat, rye or barley.
Therefore, patients with celiac disease, it is recommended to use only specially prepared products based on oats labeled. It has a mixed autoimmune, allergic, hereditary genesis, inherited in an autosomal dominant manner.
Causes of celiac disease
So, why there is gluten intolerance? As mentioned above, the exact causes are not known. But there are suggestions made in the form of theories. The most common of them - is the enzymatic and immunological, and the second most trusted scientists.
- Immunological. In the blood revealed antibodies to gluten and autoimmune antibodies to the structures of the intestinal cells. When celiac increased number of intraepithelial lymphocytes with other receptors. It is these cells see gluten as an enemy and damage the intestinal wall.
- Enzymatic. This theory is based on the absence of the small intestine enzyme capable cleaved incoming gluten. This assumption has the right to exist, however, there is no evidence of it. After all, if one adheres to the diet, the intestine enzymes are recovered in full.
- Patoretseptornaya. He believes that the intestinal surface protein composition broken due to the small intestine which has an increased sensitivity to gluten.
- Virus. Studies have shown that an overwhelming number of ill people have an increased rate of antibodies to one type of adenovirus. However, as a result of the transferred develop adenovirus infection disease can not, because it is innate. The thing is that gluten and adenovirus have similar antigenic state.
Scientists came to the conclusion that it is necessary to unite all the theory in one complex, and then get a picture of the supposed intolerance to gluten: the enzyme is not present - gluten is not split, stored, it has a toxic effect on the intestine, which reacts with the help of special cells receptors. These cells when trying to "destroy" gluten damage the epithelium of the colon, impaired digestion and absorption of food. Adenovirus took the role of a possible initiator of the immune response to gluten.
stage
celiac disease stage, depending on changes in the gut:
- Stage 0 (preinfiltrativnaya) - no change in the intestinal mucosa;
- Stage 1 (infiltrative) - highest number of intraepithelial lymphocytes;
- Stage 2 (hyperplastic) - recess intestinal crypt villus height with preservation;
- 3, step (destructive) - reversible atrophy of intestinal villi (first part, then total);
- Stage 4 (atrophic) - irreversible atrophic changes of the small intestine epithelium, often complicated oncology.
Celiac disease faced by people of different races and ages, the first symptoms of the disease can occur in childhood and in adult period.
symptoms
In the medical literature, there are three forms of clinical manifestation of celiac disease. The real picture of the disease has a variety of manifestations: celiac disease can masquerade as a variety of gastrointestinal diseases, dermatological diseases, hypovitaminosis and others. It is thanks to the variety of symptoms, celiac disease as a diagnosis is established a limited number of patients, with a greater number of patients with celiac disease continue to treat the false, but similar in symptoms diseases.
In this case, there are times when all the tests and the clinical manifestations confirm the presence of celiac disease in a patient, but after a biopsy of the small intestine, the diagnosis is not confirmed by doctors. Also worth noting is that the earlier in the food are introduced foods containing gluten and how they will be the more, the faster will begin to develop celiac disease, with the nature of the disease will be much more difficult.
Symptoms in adults
Although the disease is primarily due to the small intestinal mucosa lesions and the development of it atrophy in adult celiac disease manifests unexpressed symptoms in the gastrointestinal tract.
Adults suffering from celiac disease, can celebrate at such symptoms:
- recurrent abdominal pain and diarrhea;
- anemia and weight loss for no apparent reason;
- infertility female / male, miscarriage;
- Multiple cavities;
- hemorrhage in the abdomen and extremities;
- constant thirst, every fourth patient developed diabetes type 1;
- joint and muscle pain (in severe develop osteoporosis and arthropathy, frequent fractures);
- secondary iimunodefitsit - stomatitis, glossitis, Dermatitis herpetiformis;
- undue anxiety and irritability, prolonged depression and mood swings;
- talk by himself, performing unusual for a man of action, epileptic seizures;
- Chronic Fatigue Syndrome - dizziness, increased sweating, paroxysmal shortness of breath, weakness and often a headache;
- intestinal bleeding (black stool), in advanced cases develop lymphoma.
Symptoms of celiac disease in children
Children, patients with celiac disease, are often easy to distinguish by appearance. On the general background of weight loss is allocated swollen belly. Such children are often concerned about pain in the abdomen, a sleep disorder. They become irritable, tearful, lose their appetite. The characteristic symptom of celiac disease in children - dyskinesia bowel. Often fetid liquid foamy chair with a lot of fat.
The child in the body there is a deficiency of vitamins, minerals and protein. If time does not take action, it threatens the occurrence of stomatitis, allergic dermatitis, lesions of the nervous system, growth retardation, rachitic skeleton changes, dry skin, teeth dystrophy, iron deficiency, diabetes and other pathologies. Sometimes it may even face death.
diagnosis of celiac disease
To confirm the diagnosis, the patient will have to undergo three stages of research:
- Blood analysis. It is necessary to determine the amount of antigliadin antibodies to detect the presence or absence of antibodies endomysial, reticulin and tissue transglutaminase.
- If positive, the necessity of biopsy of the small intestine. The study will provide information on the status of the villi of the mucous membrane, whether there is an inflammatory response, and whether cells are present having altered receptors. That biopsy is the most important stage of the study.
- The patient is assigned to a gluten-free diet for a period of 6 months. If his condition improves, the diagnosis is confirmed definitively.
The diet will be appointed, even if negative biopsy results were obtained, but with positive immune tests. When gluten-free food scheme gives visible results, doctors say about the potential celiac disease.
After 12 months, the patient is again donating blood on immunological research. After another 12 months is necessary that the biopsy, the condition of the intestine must be different.
differential diagnosis
Normally, doctors do not rush to make the diagnosis "celiac disease", let alone appoint intestinal biopsy. Initially celiac disease must be distinguished from hereditary bowel disease, intestinal infections, immune deficiencies, food allergies.
Celiac disease is characterized by these pathologies, for good effect on compliance with a gluten-free diet (designated in case of positive response to immunological examination atypical antibodies), the absence of blood and feces mucus.
complications
Untreated celiac disease, complications may occur. The most common complications include:
- malignancy;
- Chronic ulcerative nongranulomatous eyunoileit and colitis;
- Neuropathy.
In patients with celiac disease and lymphoma, cancer of the small intestine develops much more frequently than in the population. In addition, more frequent, and cancer of the esophagus, stomach and rectum. Unreasonable deterioration of the patient as well as laboratory parameters, despite the adherence to a gluten-free diet must push on the idea of the likely development of the malignant process.
Celiac disease - how to treat?
Treatment for celiac disease - complex. The mainstay of treatment - a lifelong adherence to a gluten-free diet (excludes gluten-free bread, rusks, biscuits, pastry flour and pasta products from barley, oats, wheat, rye). Patients with celiac disease may be safe to eat: rice, beans, buckwheat, corn, meat, fish, poultry, vegetables, fruits, eggs and dairy products. Avoid products that contain hidden gluten in the composition - for example, some sausages, yogurt, mayonnaise, crab sticks.
In compliance with a gluten-free diet - the body weight of the patient begins to recover after 3 weeks. Histological changes in the intestines begin to fade after 2-2.5 years. Simultaneously with the appointment of a gluten-free diet - symptomatic therapy: vitamins, calcium supplements, iron, enzyme preparations, probiotics, massage, gymnastics and others. Children suffering from celiac disease, should be under medical supervision. Forecast at a diet and proper treatment - favorable.
Note that starch, containing traces of gluten, it may be a component of many food products and pharmaceuticals. Therefore - with rigid diet should be monitored, and in the absence of starch in the composition of the tablets of shells taken for the treatment of those or other problems.
Gluten may be contained in cereals or legumes, which extend at different processing facilities (grinding, removal of seeds and skins, etc.). For example, some manufacturers ordinary dry peas indicate on the package on the possible content of gluten in their products. Presumably, in such cases, getting gluten into harmless products is due to the use of the same equipment for processing of seeds of various plants.
prevention
Primary specific prevention of celiac disease does not exist. Secondary prevention of clinical signs is in compliance with a gluten-free diet.
When held by close relatives of celiac disease, it is desirable to carry out periodic inspection to identify specific antibodies. Pregnant women who suffer from celiac disease, fall into the risk of developing heart disease in the fetus. The management of pregnancy in these women should be carried out with increased attention.
Forecast
Clinical improvement was observed after a few days of special observance of a gluten-free diet, sustained improvement in 3-6 months. With good adherence to a diet relatively favorable prognosis, gastroenterologist supervision is required 1-2 times per year.
Prognosis worsens with late start of treatment, the development of refractory celiac disease, the formation of complications requiring dynamic physician and gastroenterologist supervision, consultation with other specialists (surgeon, endocrinologist, gynecologist, urologist, rheumatologist, dermatologist). Mortality rates in patients who do not comply with gluten-free diet, make up about 10-30%. Against the background of diet, this figure becomes less than 1%.
Keep in mind that gluten intolerance is saved with throughout their lives. Diet and treatment can help only to remove disturbing symptoms. In the process of development of a new style of life, you can help a society of people suffering from the same disease, the sites on the internet that specialize in the supply of gluten-free products.
