WHAT IS CELIAC DISEASE?

What is Celiac Disease?

Celiac disease is a chronic condition that occurs in people with genetic predisposition when they consume gluten-containing products. It is considered to be an autoimmune disease and while in the past we believed it to be very rare, we now know that it affects 1% of the world population.

Gluten is a combination of proteins (gliadin and glutenin) found in some cereals such as wheat, barley and rye. When celiac patients consume gluten their body triggers an immune response resulting in the destruction of small intesinal villi. The role of the small intestine is the absorption of the components of the food, and this is done through the villi. When the villi are destroyed, the body can not absorb many substances, leading to malabsorption syndrome. The clinical picture depends on the age and severity of the disease. Very often there is no symptom and the diagnosis is accidental. However, chronic diarrhoeal syndrome or rarely constipation may occur, iron deficiency anaemia, flatulence, poor weight gain, decreased growth, infertility, symptoms of vitamin and other elements deficiency, osteopenia or osteoporosis, neurological disorders, liver biochemistry disorder, delayed puberty, dermatitis, lymphoma etc. Autoimmune thyroiditis, diabetes mellitus, Down’s syndrome, or Turner syndrome may also co-occur. Relatives of celiac disease patients are more likely to develop the disease.

How is the diagnosis made?

The disease is being suspected by taking the history and blood tests. If the doctor suspects celiac disease, he will look for specific antibodies in blood tests such as antigliadin, antiendomysial and antitissue transglutaminase antibodies. Confirmation is given by gastroscopy and by taking small intestine biopsies which show lesions in the villi. There is also the genetic test of HLA histocompatibility antigens. Genetic test can be useful when the diagnosis is questionable.

What is the treatment of celiac disease?

Celiac disease is treated with a gluten-free diet for a lifetime. When the patient stops taking gluten, the villi of the intestine return to their normal condition within 6-12 months. Symptoms recede within a few weeks. In severe cases, supplements may be needed for a while until potential vitamin and trace element deficiencies are restored.
Appropriate monitoring is needed especially for children in order to check their growth, but also to check possible co-occurrence of autoimmune diseases or lymphoma in children and adults.
There is a difficulty in treatment. Gluten is very popular in commerce and is found in most standardized foods. For this reason, we should look for the special sign on the label of the package which indicates that it is gluten-free. For example, all products containing flour such as bread, toasted bread, pies, biscuits, pasta, some cold meats, beer etc. are forbidden. All fruit, vegetables, fish, poultry, dairy, rice, oil, as well as corn and corn products (e.g. corn flour) are allowed. Pharmacies sell gluten-free food (bread, biscuits, pasta made from gluten-free flour). Quite often, when gluten is in small amounts, it is not mentioned in the package thus causing a problem. Because, even when a product is made of gluten-free materials, if it is made in the same machine which has been previously used for gluten products, it may cause a problem. Even the consumption of a very small amount of gluten can cause the destruction of the villi within a few hours. In the market, there is flour, bread, pasta, beer and other gluten-free products for someone to prepare their own meal. We recommend contacting the “HELLENIC SOCIETY FOR CELIAC DISEASE” (www.koiliokaki.com) and its Facebook group (https://www.facebook.com/groups/koiliokaki/?ref=ts&fref=ts) where you can get lots of useful information about products and nutrition.

Briefly:

-Celiac disease has a genetic predisposition and is considered an autoimmune disease

-It is caused by the consumption of gluten-containing foods

-Gluten is found in products containing wheat, barley and oats, but also in plenty of standardized products.

– Patients may have no symptoms but they may have a very wide variety of symptoms

-Diagnosis is made with the detection of specific antibodies and gastroscopy by taking biopsies from the small intestine.

-The only treatment is a gluten-free diet

Vasiliki Arvaniti
Scientific Director at YODA Gastroenterological Department

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