Causes, symptoms and treatment of celiac disease in children and adults
- What is celiac disease?
- Causes of celiac disease
- Celiac Disease Symptoms
- Complications of gluten intolerance
- Diagnosing celiac disease
- Celiac Disease Treatment
- Celiac disease is not a sentence
What is celiac disease?
Celiac disease is an intolerance to foods containing gluten. A pathological reaction to this substance is given by the human intestine. This disease is congenital and inherited. Nevertheless, the full picture of its development is still not entirely clear.
Gluten that has entered the intestines cannot be completely broken down, as a result, the formation of toxins. They negatively affect the walls of the organ, damaging them. This process in childhood is accompanied by profuse vomiting, foamy stools, and bloating. If a child has gluten intolerance, then this can be understood immediately after the introduction of complementary foods, since a pathological reaction will occur after the food reaches the intestines.
Adults with celiac disease can be treated throughout their lives for flatulence, for stool disorders, unaware of the true cause of persistent dyspeptic disorders.
Since celiac disease is easily confused with chronic diseases of the digestive system, information on its prevalence is significantly underestimated. So, there is evidence that in Russia one person in a thousand suffers from the disease. Although it is not entirely correct to call celiac disease a disease. Gluten intolerance is only a person's lifestyle. He just has to adhere to a certain diet, which implies the absence of this component in products.
There are some interesting facts about gluten intolerance:
People have been suffering from this pathology for many centuries, it appeared from the moment when a person began to sow wheat, rye and other cereals for consumption;
- Most often, the female population suffers from the disease, while there are racial differences. So, in Japan, China and Africa, celiac disease is practically not diagnosed. Scientists believe that the whole point is both in the dietary habits of the population of these countries and in their genetic status;
- Some regions of Russia have not yet recognized celiac disease as a disease, so it is impossible to find such a diagnosis there;
- Some foreign scientists are of the opinion that gluten intolerance significantly affects the risk of developing cancer of the digestive system, therefore they attribute the disease to precancerous conditions;
- The risk that a child of a parent who is a carrier of the disease is 1:10.
Causes of celiac disease
Scientists have put forward theories that explain the development of the disease in humans:
- Immunological. This theory is based on the fact that people with gluten intolerance have certain antibodies to it in their blood. In addition, autoimmune antibodies to intestinal cellular structures are detected. Intraepithelial lymphocytes, the number of which is increased, perceive gluten that has entered the body as something foreign. As a result, they begin to damage the intestines.
- Enzymatic. This theory is based on the absence of an enzyme in the small intestine that can break down the incoming gluten. This assumption has the right to exist, however, there is no evidence for it. Indeed, if a person adheres to a diet, enzymes in the intestines are fully restored.
Viral. Studies have shown that the vast majority of sick people have an increased rate of antibodies to one of the types of adenovirus. However, as a result of the transferred adenovirus infection, the disease cannot develop, since it is congenital. The point is that gluten and adenovirus have a similar antigenic state.
- Patoreceptor. This theory is based on the fact that the inner surface of the intestines of sick people has certain disorders. They are associated with a violation of the protein composition in the small intestine, as a result of which it is unable to assimilate gluten.
It is worth noting that most scientists consider the immunological theory the most likely. Nevertheless, it is not worth rejecting the rest of the assumptions; it is more expedient to combine them. As a result, the following picture is formed: due to the lack of a special enzyme, the body is not able to break down gluten, as it accumulates, intestinal toxins are poisoned. He, in turn, gives a response by activating certain receptors. In this "fight", damage to the intestines occurs, its ability to digest and absorb is disrupted. As for adenoviruses, they are considered a possible provocateur of an immune response to gluten that has entered the intestines.
Celiac Disease Symptoms
The educational literature describes only three possible manifestations of the disease. However, there are much more symptoms, they are simply perceived as other pathologies of the digestive system. As a result, the correct diagnosis is rarely made, and people are treated for other diseases. Moreover, the therapy turns out to be absolutely ineffective.
However, do not forget about the existing cases of a negative intestinal biopsy for the detection of celiac disease. In this case, the entire clinical picture and blood tests indicate the presence of the disease.
In 1991, the pathology was visualized as an iceberg. At its top are people who have a genetic predisposition to developing the disease. Also at the top of the iceberg are confirmed variants that were established on clinical grounds, and there are very few of them. There is a huge proportion of people under water who suffer from the disease, but they have not been diagnosed with it. The core of the iceberg is made up of people with a genetic predisposition to the disease. It manifests itself not from birth, but as a result of exposure to negative factors, for example, after suffering stress or due to a decrease in immune strength.
In addition, the early introduction of gluten-rich foods into the diet is negatively affected. For example, semolina, which all grandmothers simply adore, can provoke the early development of the disease. In addition, the severity of the pathology will be aggravated.
Symptoms of celiac disease in children
The disease will clearly manifest itself in three symptoms:
- Increased bowel movements. The stool can be five times a day or more, it is plentiful, has a mushy consistency. There is a shine on the surface of the stool due to fat. The odor is harsh and unpleasant, the color varies, and foam may be present. Washing off feces is problematic.
- The baby's abdomen protrudes forward, which sometimes makes the doctor suspect rickets.
- In the first two years, there will be a noticeable lag in weight. After two years of age, the child's growth retardation is more pronounced. At the same time, it is worth paying attention to the fact that insufficient body weight gain will begin to manifest itself after the baby is introduced to complementary foods. Before that, his weight was normal.
If these symptoms are pronounced, then there are also other signs.
They begin to appear as a result of a lack of a child's body of many nutrients:
- The child can be passive, or, conversely, aggressive. He gets tired faster, often gets irritated.
- The skin is peeling, the hair is in poor condition. Atopic dermatitis is common.
- The child has frequent fractures uncharacteristic of childhood. Normally, they rarely happen, since the baby's bones are elastic.
- Posture disorders.
- The child looks sickly, unhappy.
- Reduced muscle tone.
- Pathologies in the oral cavity are often observed. The baby's stomatitis recurs, the gums bleed, caries develops, the enamel is in poor condition, and may crumble.
- There are signs of anemia.
- The baby may look like a spider, he has thin limbs and a protruding belly.
As the child grows up, there is a disorder of the reproductive system. Girls do not menstruate on time, and boys develop sexual dysfunction.
Symptoms of celiac disease in adults
Pathology can be latent and atypical. The latter form develops after the patient reaches 30 and even 40 years.
In general, the manifestations of the disease are as follows:
- Neurological disorders manifested in depressive disorders and migraines.
- Skin diseases such as dermatitis.
- Stomatitis, glossitis, enamel thinning.
- A biochemical blood test shows a decrease in cholesterol levels, an increase in transaminases, phosphatases and albumin.
- Arthritis. In addition, joints may hurt for an unexplained reason.
It was found that up to 8% of women suffering from infertility have celiac disease. After they started to follow a special diet, they managed to get pregnant and have a baby.
If a person suffers from a latent form of the disease, then it will not manifest itself in any way. Rarely, minor digestive upsets and dermatitis may occur. It is possible to detect pathology only by chance.
Complications of gluten intolerance
The latent form of the disease poses a certain danger if you do not know about it for a long time:
- Gastrointestinal cancers.
- An autoimmune form of hepatitis or thyroiditis
- Scleroderma, myasthenia gravis, etc.
Diagnosing celiac disease
To confirm the diagnosis, the patient will need to go through three stages of research:
- Blood test. It is necessary to determine the amount of antigliadin antibodies, to detect the presence or absence of antibodies to endomysium, reticulin and tissue transglutaminase.
- If the result is positive, then a biopsy of the small intestine is necessary. The study will give information about the state of the villi of the mucous membrane, whether there is an inflammatory reaction and whether lymphocytes with altered receptors are present. It is the biopsy that is the most important stage of the study.
- The patient is assigned a gluten-free diet for a period of 6 months. If his health improves, then the diagnosis is finally confirmed.
The diet will be prescribed even if the biopsy is negative but the immune tests are positive. When a gluten-free diet is showing visible results, doctors talk about potential celiac disease.
After 12 months, the patient again donates blood for immunological examination. After another 12 months, a biopsy is necessary, the condition of the intestines should be excellent.
Before sending a person for a biopsy procedure (it is performed under general anesthesia), it is necessary to determine if digestive disorders are the result of allergies, immunodeficiency, infection, etc.
It is important to know that with celiac disease, there will be no mucus and blood in the stool, and a gluten-free diet will give a positive result.
Celiac Disease Treatment
If a person really suffers from a disease, then he will have to adhere to a gluten-free diet all his life. To do this, it will be necessary to exclude pasta and bread, pearl barley, semolina and oatmeal from the menu, inexpensive sausages and sausages, cutlets, pastries and sauces. In addition, it is important to give up beer, cocoa, coffee, cheese, yogurt, cottage cheese, canned food, ketchup and mayonnaise.
If 100 g of the product contains 1 mg of gluten, this indicator will be critical for the patient.
Allowed for use:
- Fish and meat;
- Eggs and natural milk, as well as products based on it;
- Fruits and vegetables;
- Buckwheat, millet and corn;
- Marmalade and chocolate.
Children under 12 months old will need to eat formulas based on soy or casein hydrolyzate. When there is a need for the introduction of complementary foods, you can use gluten-free cereals.
Once the diagnosis is established, therapy for symptoms may be required:
- To restore microflora: Enterofuril (as an antiseptic), Linex, Bifiform, Actimel (as probiotics), Hilak forte (as a prebiotic).
- To normalize the digestion process - Pancreatin or Creon.
- To eliminate bloating - Plantex or Espumisan.
- To eliminate diarrhea - Imodium or Smecta.
- To normalize the water and electrolyte balance - Calcium Gluconate and Panangin.
- To gain muscle mass, a complete correction of nutrition is necessary with an increase in the calorie content of meals.
- If there are signs of vitamin deficiency, the patient will need to drink a multivitamin complex. In especially severe cases, nicotinic acid and vitamins are injected intravenously - K, A, D, E, B.
- Glucocorticosteroids are prescribed to treat autoimmune diseases.
- If a protein deficiency is detected, albumin and amino acids will be required.
In addition, it is necessary to eliminate concomitant pathologies, if any.
Patients should not take certain medications. This applies to those products that contain gluten in the capsule or shell. For example, these are Festal, Complivit, Mezim Forte and others. Also, you should not take preparations containing malt, such as Novo-Passit.
Celiac disease is not a sentence
If the diagnosis is indeed confirmed, then patients are often given a disability. However, when a person adheres to a diet, his quality of life is practically not affected, and the prognosis is quite favorable. Already after 14 days, problems with the gastrointestinal tract disappear, and after 60 days the body's water-electrolyte, mineral, vitamin and protein balance is normalized.
Children after 12 months completely catch up in physical development of their peers. However, if the diet is violated, this will lead to the return of all negative phenomena, and the risk of developing oncology also increases.
The author of the article: Gorshenina Elena Ivanovna | Gastroenterologist
Education: Diploma in the specialty "General Medicine" received at the Russian State Medical University named after N. I. Pirogova (2005). Postgraduate studies in the specialty "Gastroenterology" - educational and scientific medical center.