Intolerance to cereals (celiac disease) can develop in reaction to substance contained within the core of the grain, yet the most well-known protein contained in cereal grains is gluten. It belongs to nutrition supply proteins and is characterized by elasticity, ductility and the ability to swell in size. Gluten, which is more prevalent in wheat, is therefore responsible for the qualities of dough and its sticky nature.
Celiac disease is a hereditary disease. With first degree relatives, the occurrence is estimated at 8-18 % while with monozygotic fines, the occurrence is estimated at 70 %. Some of the symptoms of this disease are associated with inflammatory changes of the small intestine mucosa. This leads to problems in the absorption of vitamins, nutrients and water. Based on the degree of damage to the mucosa, the stage of the disease is determined. Celiac disease has many clinical forms, from fully developed to partially developed all the way to no symptoms at all.
How does gluten intolerance manifest itself?
Typical symptoms can be found in preschool children – they may be suffering from bulky and greasy stools, diarrhea, and abdomen pain as well as an enlarged belly. They may also suffer from weakened muscles. School children may not even experience any intestinal symptoms whatsoever. Typically, the problem manifests itself through malnourishment, anemia, a reduced rate of growth and an overall slowdown in development. Puberty can sometimes spell a spontaneous improvement to this otherwise incurable disease.
The disease then usually resurfaces in adulthood, usually between 25-40 years of age. The trigger can be a more serious infectious disease, physical or psychological stress, an injury or an operation. For women, the disease may appear with pregnancy, birth or breastfeeding.
In adulthood, gluten intolerance can manifest itself with non-specific digestive problems, a feeling of being full, bloated or a general loss of appetite. With adults, the symptoms are of this precarious disease highly individual-based and very diverse. The intestinal symptoms are not overly common or can be missing altogether. Sometimes, diarrhea symptoms are mild and occur in an irregular fashion.
In adulthood, many non-intestinal symptoms occur, including general fatigue, anaemia not responding to treatment, inflammation of the lining of the mouth, conjunctivitis, isolated significant increase in serum aminotransferases (AST, ALT), Duhring’s disease (skin manifestation of celiac disease), hypoplasia of tooth enamel (insufficient development), premature osteoporosis, neuropathy and myopathy. The symptoms may also include depression, behavioural problems, oligospermia (spermcount decrease), gynecological disorders (menstruation problems – delay and irregularity), spontaneous abortions or eventual infertility.
Celiac disease frequently carries with it other autoimmune diseases – most frequently an autoimmune inflammation of the thyroid gland (10–20 % of celiac disease patients), type 1. Diabetes (3–8 % of celiac disease patients) and liver/lung inflammations and other autoimmune illnesses.
Celiac disease is not diagnosed often enough
Celiac disease is often not diagnosed, i.e. many people with small or not immediately apparent symptoms are not treated. Currently, approximately 10 % of the people affected are diagnosed and under medical supervision. In the Czech Republic, the ratio is 1 ill person in 250, but that figure is likely to be higher.
Patients that were not diagnosed often spend years undergoing examinations by specialists. With women, the lack of a correct diagnosis can reset in repeat abortions, slow fetal development, low weight of a newborn and can also be associated with premature birth and the need for a C-section.
Diagnosis of celiac disease is actually quite simple. Based on a blood sample, the serum is used to determine antibodies against tissue transglutaminase or alternatively against endomysium. If the tests prove positive, an endoscopic probe is used to examine the stomach as well as the duodenum. A sample from the small intestinal mucosa (biopsy) is taken to carry out a histological examination. In order to not affect the result of the examination, the patient should not leave out gluten foods, at least until the biopsy is not carried out.
Based on new diagnosis criteria, it is possible to leave out a biopsy in children to determine the diagnosis. This can be the case when the blood sample examination shows more than ten times the upper limit of the norm and when the clinical symptoms are present. With adults however, a biopsy is necessary to determine a correct diagnosis.
How can celiac disease be treated?
The only treatment is available in the form of a life-long gluten-free diet, which is based around the complete avoidance of all raw materials, foods and beverages which contain elements of cereals (barley, wheat, rye, etc.). What is of utmost importance is to exclude all foods containing flour from the cereals mentioned above, even in trace amounts.
Celiac disease patients have to exclude all foods that contain additives containing gluten. These foods include smoked meat products, mustard, ketchup, wheat starch, baking powder, custard, chocolate, ice-cream, processed cheese and additives in various medications. However, what celiac patients can consume is rice, soy, corn, potatoes, buckwheat, millet, and amaranth or specially prepared gluten-free flour. Gluten-free foods are labelled by a crossed out wheat cob.
After eliminating gluten from the diet, uncomfortable health problems disappear in time and the patient no longer experiences earlier complications.
What complications can occur from celiac disease?
Not following the diet or late diagnosis of the disease can carry multiple complications with it. The most dangerous problem includes malignant tumours, which occur with approximately 10% of untreated celiac patients. There are more problems associated with the disease including complications in bone metabolism as well neuropsychological problems.