Celiac disease is a clinical condition which is characterised by the fact that individuals suffering from it find it impossible to digest a set of proteins which are to be found in a number of cereals such as wheat, emmer wheat, barley, rye and oats. These proteins are called gluten.
How does gluten affect the body?
When these individuals consume gluten in their diet, they produce antibodies which act against their own gut, which causes atrophy in the intestinal wall and leads to malnutrition and malabsorption.
If not treated with a diet free from gluten, in some cases it can lead to certain types of intestinal cancers.
Why do sufferers have celiac disease?
It is known that there is a genetic predisposition to celiac disease, with the result that the study of the family members of sufferers is important, and also the HLA DQ2 and HLA DQ8, which measure predisposition, should be analysed.
Transglutaminase is the enzyme which uses the gluten proteins as a substrate, mainly gliadin, the complexes formed by transglutaminase-gliadin are capable of initiating an auto-immune response in genetically predisposed individuals.
As regards the type of immuno-globin synthesised, it is mostly IgA and IgG, with in a few cases IgM being found, due to its short time in circulation in cases of gastric mucose membrane.
What symptoms warn of celiac disease?
Celiac disease is a chronic condition which may be manifested at any age, although it is popularly believed that it is a pathology which appears exclusively in paediatric patients in the fist few years of life, but the most frequent symptoms are as follows:
• Loss of weight.
• Frequent stools, soft, oily, pale and pestilent.
• Abdominal pain.
• Swelling, gases, indigestion.
• Change of character.
• Bone and joint pains.
Over the last fifteen years, the clinical presentation of celiac disease has been reconsidered, being characterised by the heterogeneity in the way it manifests itself and in the kind of symptomology which celiacs develop.
Celiac disease can be hidden for decades and can manifest itself at any stage of life. The symptoms may vary from one person to the next and may be of intestinal or non-intestinal origin. There are patients who develop the typical range of symptoms, some only have a single symptom with the presence of an atypical symptom and most celiacs do not show any symptoms at all. There are asymptomatic celiacs, or monosymptomatic or polysymptomatic celiacs.
At what age does celiac disease present itself?
Over the last few years, a great increase in its prevalence has been noticed around the world as a consequence of changes in food.
Maternal lactation and the late introduction of gluten into the diet of infants have been manifested as factors which reduce the risk of the appearance of the illness.
The age of appearance in children in the European Union is when they are weaned from maternal lactation to a diet with gluten.
In adults, it appears more frequently between the ages of twenty and forty in women and people of over forty in men. Approximately 70% of cases informed of correspond to women, at a proportion of 3 to 1.
Groups with a high degree of prevalence of celiac disease
Celiac disease is described almost exclusively in persons of white race and it is very unlikely to be found in persons of Asiatic or Black origin.
Some risk groups show a high prevalence of celiac disease. They are:
• Family members of the first or second degree of celiac patients.
• Patients with DM1 (insulin dependent diabetes mellitus) have a greater risk of suffering from celiac disease than the general population. Numerous studies confirm that this prevalence varies between 2.5% and 5%.
• Persons with thyroid immune disorders (chronic auto-immune thyroiditis, Hashimoto’s thyroiditis, and Grave’s disease) or gastro-intestinal (auto-immune hepatitis, primary cirrhosis of the liver) disorders
• Individuals with illnesses of the connective tissues (rheumatoid arthritis, Sjogren syndrome).
• Persons with Down’s Syndrome.
• Individuals with IgA deficiency.
• Individuals with neurological disorders (epilepsy, occipital cerebral calcification, ataxia, peripheral neuropathies, dementia, multiple sclerosis and leuko-encephalopathy ).
What can’t celiacs eat?
They must avoid bread, pasta and wheat, barley and rye-derived products and in broad terms and in a generalised manner, celiacs can eat fresh produce (meat, fish, milk, eggs, fruit and raw dry fruits).
How can you diagnose celiac disease?
For diagnosis, we recommend the determination of antibodies of IgA type of transglutaminase and the measurement of the total IgA Immunoglobulin, in case there is a deficiency, as the incidence of an IgA deficit is 10% higher in celiacs and in children under two years of age.
In the case of a deficit of IgA the determination of IgG is used, which is less specific but is also sensitive.
At LGS, we have a test for detecting a possible celiacs , made up of the following tests:
• Total IgA antibodies
• Antigliadin IgA antibodies
• IgA anti-Transglutaminase antibodies
If this test is positive, you will have to see your doctor for him or her to advise you.