Celiac disease was defined in 2012 as an immune-based systemic disorder caused by gluten intake in people with a genetic predisposition. It is a disease of an inflammatory and autoimmune nature that begins in the intestine, but that frequently affects other body functions, not only the digestive. It can develop at any age and is for life. It is estimated that it affects between 1% and the 2% of the population, although it's only diagnosed 1 decade 5-8 affected.
Gluten is a protein present in the grains of wheat cereals, barley, rye and oats, as well as in its natural and hybrid varieties, like spelled and kamut® (old varieties of wheat), the triticale (wheat and rye hybrid) and the tritordeum (hybrid of wheat and barley).
Celiac disease causes a characteristic inflammatory lesion in the small intestine accompanied, In most cases, of atrophy of intestinal villi. Consequently, there may be a problem of nutrient malabsorption, which leads to deficits of minerals such as iron or calcium, of vitamins like folic acid, or fat.
In early childhood, celiac disease usually manifests with digestive symptoms, such as diarrhea and / or constipation, abdominal pain and bloating, loss of appetite, growth retardation or character disturbances. In older children and adolescents there may be digestive symptoms, but it is more common to find analytical alterations, such as ferropenic anemia or hypertransaminasemia, short stature and extra-digestive symptoms, like oral thrush, joint pain, fatigue or problems with menstruation. In adults, digestive symptoms, yes there are, They are usually mild, like gas or heaviness after meals. Instead, extradigestive manifestations are quite evident: osteoporosis, bone and joint pain, numbness of extremities, muscle cramps, anemia, chronic fatigue, anxiety, depression, infertility, abortions, etc. In risk groups, how are the patient's immediate relatives, can be asymptomatic.
Diagnosis requires an analysis to assess specific antibodies in the blood and a duodenal biopsy to confirm whether there is indeed an intestinal lesion characteristic of celiac disease.. further, optionally, a genetic study can be carried out that determines whether or not the patient has a predisposition to the disease. In the case of children and adolescents who meet a series of criteria, diagnosis can be made without the need for intestinal biopsy, in the opinion of the digestive specialist. These diagnostic tests are only valid if the patient is on a normal gluten diet.
Celiac disease is associated, mainly, with immune diseases (diabetes mellitus type 1, autoimmune thyroiditis, immunoglobulin A deficiency) and chromosomal syndromes (Down, Turner, Williams).
Celiac disease treatment consists of a strict gluten-free diet throughout life, which implies a clinical and functional normalization, which includes the regeneration of intestinal damage. The gluten-free diet implies consuming only those foods in which the absence of gluten is guaranteed.
Dermatitis herpetiformis is a cutaneous manifestation of celiac disease that affects a 5-6% celiac. It is diagnosed by biopsy of healthy skin and the treatment is the gluten-free diet.
Ataxia is a neurological problem that affects movement coordination and can be caused by gluten.. It is diagnosed in patients with symptoms of ataxia who have specific antibodies to celiac disease in their blood and improve when eating a gluten-free diet., although the degree of improvement depends on how advanced the disease is.
Non-celiac gluten sensitivity
The concept of non-celiac gluten sensitivity is very recent and is applied to patients with symptoms of celiac disease that improve when eating a gluten-free diet, after ruling out celiac disease and wheat allergy. It is estimated that it affects 1-6% of the population, although at the moment there are no specific diagnostic tests nor has it been shown that gluten is the cause.
Food allergy to gluten
Food allergy to gluten is a rapid immune reaction, sometimes severe, that occurs after ingesting foods that contain gluten. It can cause from a simple skin reaction to an anaphylactic shock that puts the patient's life at risk. It can also manifest with digestive symptoms that are confused with those of celiac disease.. It is diagnosed using specific skin tests and immunoglobulin E detection. (IgE) specific wheat in the blood. Confirmed with a controlled provocation test at a healthcare facility. Affects less than 0,1% of the population.
Continued consumption of gluten, even in small quantities, can cause significant and undesirable long-term disorders, still no symptoms, like neurological problems (migraines, hyperactivity, attention deficit, memory loss, early dementia), psychiatric (anxiety, depression), reproductive (infertility, abortions), bone and muscle (joint pain, osteoporosis, increased risk of fractures, weakness), among others.
Diseases caused by eating gluten foods should not be an obstacle to the development of a normal life, as they cease to be a problem once properly diagnosed and treated, despite the limitations of a gluten-free diet.
Parents of celiac children should not prohibit them from attending parties, birthday or school camps. They should speak to those responsible for these activities in order to inform them about the diet they must follow and the importance of not violating it..
In the same way, adult patients do not have to be limited when carrying out any activity, although they must pay special attention when choosing the products they consume.
In most cases, the relationship with other patients is a source of mutual help in understanding these pathologies, properly carry out the gluten-free diet and overcome the difficulties that arise on a daily basis, for which the Association of Celiacs and Sensitive to Gluten of the Community of Madrid offers all its help and support.