Taking into account both the classic and atypical forms, it is now believed that about 1 in 250 to 500 people suffer from a sensitivity to gluten. Of these, however, only about 10 to 20 percent exhibit the symptoms typical of celiac disease.
Celiac disease: risk groups
Celiac disease is commonly observed in:
- Diabetes mellitus (type 1),
- Lactose intolerance,
- Osteoporosis,
- Thyroid disease,
- Rheumatoid arthritis and
- In Down syndrome.
1st and 2nd degree relatives are also affected more often than the average population. These individuals should be screened, especially if one or more of the typical signs appear.
Celiac disease patients suffer clustered diabetes type 1. Both diseases are based on errors in the immune system. Presumably, a genetic gluten hypersensitivity leads to a chain reaction in which cells of the immune system overreact and attack the body’s own tissue (autoimmune disease). If certain cells of the pancreas are destroyed, an insulin deficiency develops and thus diabetes.
How is the diagnosis made?
In addition to clinical symptoms, the basis for diagnosis is the detection of specific antibodies (against transglutaminase, endomysium, and gliadin) in the blood and the examination of a tissue sample of the mucosa of the small intestine under the microscope.
The endoscopic small bowel biopsy commonly performed today is harmless and takes no more than 10 to 15 minutes. During this procedure, a camera probe is inserted into the small intestine via the mouth, esophagus, and stomach, and several tissue samples are taken and then examined under a microscope.
The antibody test cannot replace a small intestine biopsy. Especially in children, the reliable diagnosis by biopsy is important, because if the diagnosis is positive, they will have to eat gluten-free for the rest of their lives. If the symptoms improve under a gluten-free diet, this confirms the diagnosis.
Almost all patients show typical changes on a specific gene; however, since a quarter of healthy people also have it, it is not useful for making a diagnosis, but if absent, it speaks against celiac disease.
What therapy is available for celiac disease?
The only treatment available to date is complete, lifelong abstinence from foods containing gluten. Only in this way can the mucosa of the small intestine recover and regain its function. However, even the smallest amounts of gluten cause renewed damage and discomfort.
In most cases, symptoms improve within a few weeks after the change in diet and then disappear completely.
Can celiac disease be prevented?
It is not yet definitively clear why celiac disease occurs in some people, but it appears to be due to a genetic predisposition. The only preventive measure currently recommended is to avoid foods containing gluten in infants younger than six months.
Once celiac disease has been diagnosed, a consistent diet can prevent subsequent illnesses.
