Celiac disease is an autoimmune disease that damages the small intestine in response to gluten. Learn about symptoms, diagnosis and effective treatment.

What is celiac disease?

Celiac disease is a chronic autoimmune disease that affects the lining of the small intestine and is caused by a reaction to gluten, a protein found in wheat, barley and rye. When celiac patients consume a gluten-containing diet, their immune system mistakenly attacks the intestinal villi, which damages the lining of the small intestine and interferes with nutrient absorption. Celiac disease is a common disease worldwide and affects about 1 in 100 people, but many people can go their entire lives without being diagnosed with the disease.

The disease can appear at any age, but it is more often diagnosed in childhood or adulthood, when symptoms that indicate a bowel disorder appear. Celiac disease is not just a digestive problem; it is a complex disease that can affect many body systems and cause various complications if it is not diagnosed and treated in time.

Celiac disease causes and risk factors

Celiac disease occurs when the body's immune system mistakenly reacts to gluten and attacks the intestinal lining. The exact causes of celiac disease are not fully understood, but there are several factors that increase the risk of developing the disease:

1. Genetics: Celiac disease has a strong association with genetic factors. People whose first-degree relatives suffer from celiac disease have a high risk of developing the disease. Celiac disease is often associated with certain HLA-DQ2 and HLA-DQ8 genes.
2. Environmental factors: Environmental factors, such as exposure to gluten in early childhood, when the immune system is not yet fully developed, or certain viral infections (such as rotavirus) can increase the risk of developing celiac disease. Exposure to gluten at such an early age can increase the immune system's response to gluten, especially in children with a genetic predisposition to the disease.
3. Autoimmune diseases: People with celiac disease often have other autoimmune diseases, such as type 1 diabetes or autoimmune thyroiditis.

What are the symptoms of celiac disease?

The symptoms of celiac disease can be extremely diverse and vary from patient to patient, which makes diagnosing the disease difficult. Some of the most common symptoms of celiac disease include:

1. Digestive disorders: Celiac disease often causes digestive problems such as chronic diarrhea, flatulence, abdominal pain and constipation.
2. Weight loss and nutrient deficiencies: due to a damaged intestinal lining, the body is unable to fully absorb nutrients, resulting in weight loss and nutrient deficiencies, which can lead to anemia, calcium deficiency, and other vitamin deficiencies.
3. Fatigue and weakness: Chronic fatigue, weakness and apathy are common in patients associated with nutrient deficiencies.
4. Mood changes: Celiac disease can affect mood and cause depression, irritability or anxiety.
5. Rashes on the skin: Some patients develop dermatitis herpetiformis, an itchy rash that often appears on the elbows, knees or buttocks. This type of rash occurs as an autoimmune reaction to gluten, which is a classic sign of celiac disease.
6. Osteoporosis and bone pain: Calcium and vitamin D deficiency can lead to osteoporosis and increased risk of bone fractures. If blood calcium is below 2.1 mmol/L and vitamin D is below 50 nmol/L, there is a high risk of osteoporosis. A vitamin D level between 60 and 75 nmol/L is considered good, so keeping it in that range is recommended. It is recommended to have a DEXA scan to assess bone density and discuss the need for calcium and vitamin D supplements with your doctor.
7. Growth disorders in children: In children, celiac disease can cause delayed growth and puberty, as well as unexplained weight loss.

It is important to consult a healthcare professional with any symptoms of celiac disease. Early diagnosis can help control the course of the disease more effectively and improve the quality of life.

Diagnosis of celiac disease

Diagnosing celiac disease is often challenging because symptoms can overlap with other diseases, such as irritable bowel syndrome (IBS) or lactose intolerance. Several methods are used to diagnose celiac disease:

1. Blood tests: Blood tests are used to detect antibodies that indicate celiac disease. tTG-IgA and EMA antibodies are most commonly sought. If the tTG-IgA level is more than 10 times higher than the norm, it very likely indicates celiac disease. A normal level of tTG-IgA is up to 7 U/mL, and EMA antibodies are used to confirm the diagnosis if tTG-IgA is positive.
2. Endoscopy and biopsy: To confirm the diagnosis, an upper endoscopy is often performed, during which tissue samples (biopsy) of the small intestine are taken. A biopsy may show lesions in the intestinal villi that are characteristic of celiac disease.
3. Genetic tests: Testing for the HLA-DQ2 and HLA-DQ8 genes can help rule out celiac disease, as the absence of these genes virtually rules out the disease.

Treatment of celiac disease

Treatment for celiac disease is based on a strict gluten-free diet, which is the only effective therapy for managing the disease. Following a gluten-free diet helps prevent symptoms, allows the small intestine to regenerate and reduces the risk of complications. The main treatment options and strategies are described below:

1. Gluten-free diet: Celiac patients should avoid foods containing wheat, barley and rye. This means avoiding most breads, pastas, cookies, beer, and other products that may contain gluten. Gluten can also be found in many processed foods, such as sauces and soup powders, so it's important to read product labels carefully when evaluating their ingredients.
2. Nutritional supplements: Many celiac patients, especially in the initial stages after diagnosis, may need nutritional supplements to compensate for nutrient deficiencies caused by intestinal damage. This may include taking supplements of iron, calcium, vitamin D, vitamin B12 and folic acid.
3. Avoidance of cross-contamination: Avoiding cross-contamination when gluten-containing foods come into contact with gluten-free foods is very important for celiac patients. This can happen in the kitchen while cooking, or even when storing food. Cooking food separately and washing utensils thoroughly can help reduce the risk of contamination.
4. Regular medical examinations: Celiac disease is a chronic disease and its management requires long-term control. Patients should have regular medical check-ups to ensure that their nutrient levels are adequate and that other related problems such as osteoporosis or anemia have not developed.
5. Gluten enzymes: Gluten-breaking enzymes are also available, but note that they are not a substitute for a gluten-free diet. These enzymes can help reduce exposure to gluten, but they are not enough to fully protect against intestinal damage. Enzymes are proteins that act as biological catalysts and assist in biochemical processes in the body. In this context, "gluten enzymes" are special enzymes that can break down gluten in food before it can cause harmful effects in celiac patients. Although these enzymes can be helpful, they cannot replace a strict gluten-free diet because there is no guarantee that they will completely destroy gluten, and even small amounts of gluten can cause intestinal damage in celiac patients.

What are the complications of celiac disease?

If celiac disease is not diagnosed in time or if a gluten-free diet is not followed, the disease can cause several complications, which can be serious:

1. Lack of nutrients: Inadequate absorption of nutrients can lead to deficiencies of iron, folic acid, calcium, vitamin D and other essential nutrients, which can lead to anemia, osteoporosis and other health problems.
2. Osteoporosis: insufficient levels of calcium and vitamin D can lead to a decrease in bone density, leading to osteoporosis and an increased risk of bone fractures. If your blood calcium level is below 2.1 mmol/L and your vitamin D level is below 50 nmol/L, it is recommended to see your doctor as this indicates an increased risk of osteoporosis and bone fractures.
3. Neurological problems: Celiac disease can cause neurological symptoms such as ataxia (impaired movement coordination) or peripheral neuropathy (tingling, numbness in arms and legs).
4. Infertility and complications during pregnancy: Women with undiagnosed or untreated celiac disease may have an increased risk of infertility, miscarriage, or other complications during pregnancy.
5. Intestinal cancer: A small percentage of patients with untreated celiac disease may face an increased risk of bowel cancer or other types of lymphoma.

New treatment methods for celiac disease

Although current treatment for celiac disease relies on a gluten-free diet, researchers are actively working to develop new treatments that could make life with celiac disease easier:

1. Immunotherapy: Researchers are developing vaccines that could "train" the immune system not to react to gluten. This approach could significantly reduce or even eliminate the need for strict dieting.
2. Gluten neutralizing enzymes: Research is developing enzymes that could break down gluten into smaller, harmless components before they reach the intestines. These enzymes could potentially help repair damage caused by gluten.
3. Protection of the intestinal barrier: some of the newer approaches focus on strengthening the small intestinal barrier to prevent gluten from entering and thus causing an autoimmune response.

Life with celiac disease

Living with celiac disease can be challenging, but with proper nutrition and appropriate measures, it is possible to live a fulfilling life. Here are some suggestions to help people with celiac disease manage their condition:

1. Nutrition education: It is important to educate yourself about the gluten-free diet and know which products are safe to use. It is recommended that you consult a nutritionist to understand how to balance your diet and provide all the necessary nutrients.
2. Shopping and cooking: Careful shopping and cooking is essential. Celiac patients should carefully read the ingredients of products to make sure they do not contain gluten. Many stores now have dedicated gluten-free sections, which can make shopping easier.
3. Communication with other people: People with celiac disease may benefit from joining support groups where they can share their experiences with others who are facing similar challenges. It helps reduce emotional stress and provides practical advice such as safe eating out recommendations.
4. Eating out: Eating out can be tricky, but possible with the right precautions. Before visiting a restaurant, it's a good idea to check if the place offers a gluten-free menu and always ask questions about the ingredients and the cooking process to avoid the risk of cross-contamination.

Early diagnosis and initiation of treatment can help control the course of the disease more effectively and improve quality of life. In case of outbreaks of symptoms or worsening of existing symptoms, you should immediately seek medical help to avoid complications and receive the necessary treatment in time.

Conclusion

Celiac disease is a chronic and complex disease that requires a strict gluten-free diet to avoid complications and improve quality of life. Early diagnosis and diet are key steps in managing this disease and leading a full life. As new treatments continue to be developed, it is hoped that the management of celiac disease will become even more effective and less restrictive in the future. It is important that patients with celiac disease receive both medical and emotional support to help them overcome daily challenges and ensure a better quality of life.

Additional resources

• What you need to know about the gluten-free diet (Source: Centers for Disease Prevention and Control)
• Vita Skuja: Diseases related to gluten intolerance When to really blame gluten? (Source: doctor.lv)
• Celiac disease and gluten sensitivity (Source: Doctus)
• Myths about celiac disease (Source: Gluten Free Life)