Celiac disease is a disease in which an adult in the small intestine does not produce certain enzymes responsible for the breakdown of gluten, which leads to disruption of the gastrointestinal tract and various unpleasant symptoms. In this condition, any foods containing gluten cause all kinds of negative reactions from the intestine, which affects the general well-being of the patient and leads to an inflammatory process. Gastroenterologists with the participation of geneticists and other specialists are engaged in the assessment of symptoms, diagnosis and treatment of celiac disease in adult patients.
About the disease
Celiac disease, also known as gluten enteropathy or gluten intolerance, is an autoimmune condition that is inherited. Basically, pathology is detected in women: up to two times more often than in men.
With such a disease, the body’s immune defense perceives gluten as a hostile element and triggers an inflammatory process in the small intestine. As a result, the processes of nutrient absorption are disrupted, which is why, in addition to signs of gastrointestinal damage, celiac disease in adults is accompanied by a decrease in body weight and general exhaustion.
The classification of celiac disease implies the identification of several types of the disease, taking into account various parameters.
According to the clinical signs , gluten enteropathy is distinguished:
- a typical form when it manifests itself in childhood at 1-3 years of age and is accompanied by characteristic symptoms;
- erased type, in which signs of the disease occur under certain circumstances at different periods of the patient’s life, and extra-intestinal symptoms (bleeding gums, bone fragility, etc.) come to the fore;
- latent form, when the pathology proceeds without pronounced signs, which is most typical for elderly patients.
Taking into account the stage of development and the degree of activity of the inflammatory process in the gastrointestinal tract , specialists distinguish the following stages of celiac disease:
- latent, characterized by the absence of signs of pathology, although the inflammatory process has already started;
- active, which reveals typical signs of gluten intolerance (dyspepsia, flatulence, diarrhea, etc.);
the stage of incomplete remission, when most of the symptoms are eliminated during treatment, but the inflammatory process has not yet been suppressed;
- the stage of complete remission, in which the disease is completely controlled, and the signs of gluten enteropathy disappear;
- the stage of decompensation, at which the symptoms of the disease reappear after remission.
Gluten intolerance in adult patients is primarily accompanied by symptoms of damage to the digestive tract. Come to the fore:
- increased gas formation;
- frequent diarrhea;
- abdominal pain that occurs after eating;
- rapid fatigue;
- feeling of heaviness after eating.
A characteristic sign of gluten intolerance is feces of a special, greasy consistency, which is poorly washed off, sticks to the walls of the toilet bowl, with insufficient hygiene leaves poorly washable stains on underwear.
With a prolonged course of the disease , the symptoms of celiac disease become:
- body weight deficit;
- softening, fragility of bones (osteoporosis);
- darkening of tooth enamel;
- frequent headaches;
- chronic fatigue;
- the appearance of an itchy rash on the skin in the form of bubbles;
- constant heartburn;
- joint pain;
- muscle weakness;
- constant rumbling in the stomach;
- unpleasant burp;
- joint pains.
With gluten enteropathy in the active phase, various neurological signs can also be observed, including:
- numbness of the limbs;
- tingling sensation, goosebumps on the skin;
- coordination disorder;
- decreased attention, memory, concentration.
The condition may also be accompanied by increased drowsiness, decreased performance, when it is difficult for the patient to concentrate on work tasks. Some patients note that they have become worse at perceiving new information, they hardly manage to master additional skills, get used to changes in the surrounding work environment. Due to the thinning and fragility of bone tissues, frequent fractures can be observed, which heal poorly and for a long time.
The key cause of celiac disease is a genetic defect that causes an excessive immune response to gluten. Some studies have shown that, under certain circumstances, intolerance to this peptide can develop as an independent autoimmune process against the background of other diseases: diabetes mellitus, systemic lupus erythematosus, thyroiditis, etc.
The manifestation of the disease is caused by the consumption of food containing cereals: rye, barley, wheat. These products include:
- bakery products;
- bakery products;
- ice cream;
- flour confectionery products;
- thick sauces and dressings;
- breakfast cereals;
- fast food;
Gluten as a thickener is massively used in the production of many products, therefore, the rash consumption of any dish can provoke the activation of the inflammatory process.
During the initial examination, a gastroenterologist conducts a physical examination, evaluates the appearance of the patient’s skin, teeth, and interviews for complaints. Careful collection of anamnesis is of great importance in the initial diagnosis of celiac disease: when interviewing a patient in 95% of cases, it turns out that similar problems exist in his close relatives. The doctor also needs to know the nature and characteristics of nutrition, general lifestyle, and the presence of other diseases.
Laboratory methods for the diagnosis of gluten intolerance include:
- a biochemical blood test that allows you to detect a decrease in albumin, anemia, deficiency of key nutrients and minerals;
- determination of the titer of specific antibodies that are formed in celiac disease (tissue transglutaminase, gliadin peptides);
- the Schilling test or other studies to assess the quality of absorption in the small intestine.
If necessary, an endoscopic examination of the small intestine with a biopsy is also prescribed. Additionally, ultrasound examination of the abdominal cavity, computer or magnetic resonance imaging, if necessary, intestinal radiography with the use of a contrast agent are shown.
Many patients are quite negligent about such a disease as celiac disease. Systematic diarrhea, flatulence, dyspepsia in the initial stages of pathology do not seem threatening symptoms to them, which is why people postpone diagnosis and treatment, continuing to consume potentially dangerous products. As a result, the inflammatory process is becoming more extensive, the symptoms are increasing, there are prerequisites for the development of serious complications. These include ulcerative intestinal lesions, persistent iron deficiency anemia, internal bleeding, perforation of the intestinal wall, peritonitis, osteoporosis and even infertility, which occurs as a symptom of prolonged malabsorption (impaired absorption of nutrients in the intestine). In addition, patients with uncontrolled celiac disease have a constant increase in blood pressure, they sleep worse, have problems with memory and attention, become irritable, sometimes even aggressive. Do not ignore the frequently recurring symptoms and write them off as ordinary indigestion. It is necessary to seek medical advice immediately.
The tactics of therapy depends on the type of celiac disease, the stage of the inflammatory process, the severity of clinical manifestations, etc. The main condition for effective treatment is a complete rejection of products containing gluten. Any products containing rye, wheat, barley flour or several cereals at once should be banned. It is very important to carefully study the composition indicated on the package before buying or using new products.
Traces of gluten can be found in products such as:
- sausages, sausages and sausages;
- meat delicacies;
- ready-made chilled and frozen meat and vegetable dishes;
- fast food;
- instant coffee, chicory;
- soy milk and its derivatives;
- breakfast cereals;
- vegetable sauces and dressings;
- canned fish and meat;
- chewable candies and caramel;
- broth cubes and other concentrates;
- ice cream;
- kvass and beer.
Additionally, along with the correction of nutrition and a strict diet for celiac disease, drug treatment is carried out, which consists in taking hormonal and anti-inflammatory drugs to suppress the inflammatory process in the small intestine. Vitamin and mineral complexes and dietary supplements can be used to restore the balance of nutrients in the body.
It is also necessary to monitor the existing other diseases in the patient by conducting appropriate supportive therapy.
There are no specific ways to prevent the development of gluten intolerance. It is important to control autoimmune pathologies, prevent relapses, regularly undergo preventive examinations and take tests.
An important point: celiac disease in pregnant women can lead to various malformations of the fetus, in particular, the cardiovascular system, therefore, during the bearing of a child, such patients should be under special control.
The prognosis depends most on the patient’s behavior and his willingness to follow the doctor’s recommendations. With strict maintenance of a gluten-free diet, the condition of most patients normalizes. They are shown regular monitoring and laboratory diagnostics with a frequency of at least 1 time per year.
In some cases, when patients react poorly to the elimination of gluten-containing products from the diet, there is a tendency to worsen, dispensary monitoring is carried out more often: up to 4-8 times a year.