Celiac

Background

The “gluten” protein is a protein mixture found in many grains such as wheat, rye, barley, and spelt. Its high content of the amino acids glutamine and proline makes gluten resistant to breakdown by digestive enzymes in the intestines, which contributes to the inflammatory response. Gluten has elastic properties and is therefore an important component of bread, for example, to which it gives its unique taste and consistency.

Symptoms

Celiac disease can manifest locally in the intestine in digestive symptoms. Diarrhea is a typical and common symptom. Other digestive symptoms such as vomiting, weight loss, bloating, distended abdomen, abdominal pain, and loss of appetite are observed. Constipation is rare and may occur paradoxically. Celiac disease is also often accompanied by other autoimmune disorders. These include:

Diabetes mellitus type 1
Autoimmune thyroiditis, hepatitis.
Dermatitis herpetiformis, a highly itchy skin disease.
Sjörgen’s syndrome
Circular hair loss

Complications

Due to the inadequate absorption of important nutritional components, numerous symptoms and complications also occur outside the intestinal tract. Carbohydrates, fats, proteins, vitamins (eg, folic acid, vitamin B12, fat-soluble vitamins), minerals (eg, calcium, iron) and trace elements are insufficiently absorbed. The symptoms differ according to age and sex. A symptomless course is also possible.

Osteoporosis, bone pain and enamel disease due to calcium and vitamin D deficiency.
Anemia due to iron deficiency, vitamin B12 deficiency or folic acid deficiency.
Oral mucositis, aphthae, tongue inflammation, hair problems, among others, due to a zinc deficiency.
Developmental disorders in children, short stature, mental disorders.
Infertility, libido disorders
Neurological dysfunction such as movement disorders and convulsions.
Fatigue, feeling of illness, weakness

Untreated celiac disease can very rarely result in serious complications. These include the formation of intestinal ulcers with a risk of bleeding, small intestinal and esophageal carcinomas and non-Hodgkin’s lymphoma. Refractory sprue is characterized by persistent villous damage despite diet.

Causes

Gliadin from gluten is difficult to digest and can partially penetrate the epithelial barrier of the intestine, where it triggers an inflammatory immune response in predisposed individuals. This reaction, caused by the innate and adaptive immune system, is the reason for the damage to the mucosa of the small intestine, which manifests itself in flattening of the villi of the small intestine (villous atrophy) and enlargement of the crypts (crypt hyperplasia). Gluten intolerance results from the interaction of genetic and environmental factors. Risk factors include:

Heredity: genetic predisposition plays a crucial role. Siblings of identical twins are also affected in 85% of cases. Numerous genes are involved in the development, significant among them are the alleles HLA-DQ2 and HLA-DQ8.
Gender: women are more often affected than men.
Ethnicity: Europeans and North Americans are more likely to suffer from celiac disease than Asians. Whites have an increased risk than blacks.

Early exposure to gluten in children, early infections with enteropathic viruses, or alteration of intestinal bacterial flora may pose a risk for developing gluten intolerance in childhood. Breastfeeding, on the other hand, has a protective effect.

Triggers

Triggers include foods containing gluten, such as pasta, bread, breadcrumbs, fish, pizza, cakes, pies, beer, and malt beverages. Damage to the mucosa of the small intestine is caused by the alcohol-soluble fraction of gluten. Even the smallest amounts of gluten can cause mucosal damage.

Diagnosis

Diagnosis is made by medical treatment based on clinical symptoms and laboratory methods. Serologic tests are available (antibody-based tests of the patient’s blood, e.g., anti-transglutaminase IgA, anti-endomysium antibodies). Gastrointestinal endoscopy with a sample from the upper small intestine and fine tissue examination of this sample plays an important role.Because of the nonspecific symptoms, numerous differential diagnoses are possible, for example, lactose intolerance, irritable bowel syndrome, cow’s milk protein allergy, infectious gastroenteritis, tropical sprue, and small bowel cancer.

Nonpharmacologic treatment

The effective nonmedicinal treatment for celiac disease is lifelong, absolute, and consistent adherence to a gluten-free diet. Even ingestion of small amounts of gluten is not an option. The diet not only achieves freedom from symptoms, but at the same time reduces the increased risk of cancer. A variety of gluten-free foods are commercially available from different suppliers. Wheat, barley, rye, barley and spelt must be avoided. The classic substitutes for bread and other foods are corn and rice. In addition, sourdough, flax, Indian psyllium, buckwheat, peas, chestnuts, soy, quinoa, cassava, potatoes, nuts, beans and vegetable fibers are also used. Fruits, vegetables and meats are also gluten-free. Oats remain controversial because they can be contaminated with other grains. Once the diet is started, it takes days to weeks, and possibly months to years, for the lining of the small intestine to recover.

Drug treatment

Treatment and prevention of nutrient deficiency: nutrient deficiency, such as iron deficiency, osteoporosis, and vitamin B12 deficiency, is treated by giving the appropriate minerals and vitamins. To prevent deficiencies, taking a vitamin/mineral supplement is recommended. Causal treatment: scientists are interested in developing pharmacological approaches to celiac disease. All drugs are currently under development or in the clinical phase.