Celiac disease

Celiac disease or gluten intolerance is a small bowel disease with a genetic/genetic background in which the body produces antibodies when the patient consumes gluten, a protein found in wheat, barley, oats and rye, which attack and destroy the cells of the small intestine. When celiac disease patients eat foods containing gluten, their immune system reacts by destroying the villi in the small intestine so that the food components are not absorbed. As the small intestine is where the absorption of nutrients from the diet takes place, celiac disease can cause various symptoms associated with nutrient malabsorption.

Symptoms

​Several patients suffering from celiac disease may have no symptoms (subclinical celiac disease) which makes the diagnosis of celiac disease quite difficult. When patients do experience symptoms these are usually diarrhoea, flatulence, abnormal mouth ulcers, alternating stools, symptoms of indigestion, abdominal pain, production of foul-smelling gas and weight loss. Often patients with celiac disease as mentioned above may not show symptoms but due to chronic malabsorption of nutrients, they develop extra-intestinal manifestations such as osteoporosis, anaemia, mainly iron malabsorption, liver enzyme disorders, hypogonadism, growth retardation in children and weight loss.

The disease usually coexists with other autoimmune diseases such as autoimmune thyroid diseases, , rheumatological diseases such as rheumatoid arthritis and Sjogren's syndrome , type 1 diabetes mellitus, but also other diseases of the digestive tract such as idiopathic inflammatory bowel diseases, or autoimmune liver diseases such as autoimmune hepatitis, primary biliary cirrhosis or sclerosing cholangitis.

The presence of herpetic dermatitis is also a disease that is significantly associated with the presence of celiac disease.

How is celiac disease diagnosed?

The diagnosis of celiac disease is primarily made by performing blood tests and detecting antibodies that fight the presence of gluten in the blood. Patients with celiac disease have higher than normal levels of these antibodies (antibodies against transglutaminase - anti-tTG, antibodies against endomysial - anti-endomysial). In some patients with IgA deficiency, the results may be false negative and confirmation of the diagnosis by other methods may be necessary.

Gastroscopy with biopsies of the small intestine is considered the method of choice for the diagnosis or confirmation of the diagnosis of celiac disease and the assessment of the severity of the disease.

 During the gastroscopy, the doctor takes biopsies from the lining of the small intestine and mainly from the 12 intestine, which will confirm the diagnosis of celiac disease.It is extremely important that before the gastroscopy or biopsies are taken, the patient follows a gluten-free diet without limiting gluten consumption.

Finally, in some cases, genetic testing may be required for the diagnosis of celiac disease, especially in patients where there is a strong suspicion but the above tests are not fully diagnostic. Genetic (HLA) testing More than 99% of patients with celiac disease are carriers of the HLA DQ2, HLA DQ8 or part of the HLA DQ2 or HLA DQ8 genes. However, genetic testing alone cannot diagnose celiac disease as not all patients carrying these genes will develop celiac disease. However, if patients do not carry the specific genes directly, the diagnosis of celiac disease is excluded

Treatment of celiac disease;

​The treatment of celiac disease consists of the complete exclusion of gluten from the diet - gluten-free diets. The elimination of gluten is the only treatment for the disease. The gluten-free diet can be quite difficult and may require modification of the patient's lifestyle and therefore, consultation with a dietician is recommended. In most cases, stopping gluten from the diet will mean the elimination of symptoms and at the same time any alteration caused to the small intestine will heal and prevent any further damage.