Celiac disease, also known as sprue, is a form of gluten intolerance. The small intestine consists of thousands of folds and protrusions called villi, which in turn are covered with millions of tiny hairs. This increases the inner intestinal surface area by a factor of 300 and the area through which nutrients are exchanged by 100 to 200 square meters. This is a highly effective mechanism, but one that is also susceptible to disease. It is true that nature succeeds with this trick in providing a huge exchange area in a small space. But conversely, this also shrinks quickly if the villi change pathologically, which leads to problems with food intake and utilization. This is exactly what happens in celiac disease.
What is celiac disease and how does it manifest?
Celiac disease is a chronic disease of the small intestine. As it appears, in celiac patients, an incorrect amino acid is incorporated into a protein produced by the body that is used in the recognition of enemies. As a result, gluten, a gluten protein found in grains, is bound to these immune cells for longer and triggers a – actually unnecessary – foreign body reaction. However, the immune cells not only attack the gluten, but also damage the intestinal mucosa: The intolerance to gluten causes the small intestinal bulges to shrink. This means that fats, sugars, proteins, vitamins, minerals and even water can no longer be absorbed properly into the body. The lack of these substances, in turn, leads to a wide variety of symptoms and complaints – no two cases of illness are identical.
Celiac disease, sprue or gluten intolerance?
In the past, a distinction was made between celiac disease and sprue: if the disease occurred in childhood, it was referred to as celiac disease; if it was diagnosed in adulthood, it was referred to as (indigenous) sprue. Today, it is only referred to as celiac disease, since it is the same disease and not two different disorders, as was assumed at the time. The terms gluten intolerance or gluten intolerance are also commonly used. These are rather umbrella terms: In addition to celiac disease, gluten intolerance can also mean gluten sensitivity. In this case, in addition to digestive disorders, symptoms may occur that are uncommon in celiac disease, such as migraine, depression or muscle pain. Gluten sensitivity can occur suddenly and also only temporarily.
Classic form of celiac disease
The classic symptom is diarrhea: the undigested fats are excreted with the stool, which is therefore bulky and foul-smelling. Sufferers suffer from flatulence, lose weight, and are prone to iron deficiency and anemia. Muscle wasting, water retention, increased skin pigmentation and hair loss may occur. Various signs of vitamin and calcium deficiency such as clotting disorders and osteoporosis also occur. After a longer course, insomnia, fatigue or depression may also be possible symptoms. In children, symptoms first appear as soon as supplementary feeding of a porridge diet with cereal products is started – i.e. usually from the 6th month of life. Babies have no appetite, abdominal pain, a distended abdomen and often defecate large, bad-smelling amounts of stool. They do not gain weight properly and may develop signs of anemia and dehydration. A “tobacco pouch buttocks” is typical, as fat reserves are broken down in the buttocks, and a disgruntled, tearful facial expression is a sign of irritability and even a change in character. Not infrequently, child development stagnates or even regresses.
Atypical forms of celiac disease
Insidiously, nearly half of patients do not show gastrointestinal symptoms. Instead, the disease may manifest with only one or more of the following symptoms:
- Skin lesions (dermatitis herpetiformis Duhring).
- Iron deficiency, short stature
- Gum shrinkage
- Joint problems
- Liver inflammation
- Osteoporosis
- Depression, irritability, fatigue
- Limited fitness
- In women to frequent miscarriages or infertility
These atypical courses are difficult to detect, and it is not uncommon for patients to have gone through a years-long odyssey before celiac disease is diagnosed.
What is gluten and what effect does it have?
Gluten is a gluten protein composed of the proteins prolamin and glutelins.It is of central importance for the baking properties of flour and is found primarily in the cereals wheat, spelt, rye, barley and oats – and thus in numerous foods. Gluten contains gliadin, which can cause a reaction of the immune system, resulting in the formation of antibodies. These are directed against the intestinal mucosa and lead there – even in the smallest quantities – to inflammation and, in the long term, to severe damage. The villi flatten, the surface shrinks, and insufficient digestive enzymes are produced. Due to these processes, one also speaks of a gluten-sensitive enteropathy (= intestinal disease). As a result, the body is no longer able to absorb sufficient nutrients, leading to deficiency symptoms. If the disease is prolonged, the constant inflammatory reactions can lead to an increased risk of cancer (lymphoma).
