Celiac Disease
Can celiac disease be cured? All the information about this disease: causes, symptoms, and treatment.
Symptoms and Causes
Celiac disease, or celiac condition, is a multisystemic, autoimmune, and chronic disease characterized by inflammation of the mucous lining of the small intestine, which impedes the proper absorption of nutrients. It is caused by a permanent intolerance to gluten, a protein found in wheat, barley, and rye, as well as their hybrids and derivatives. Although celiac disease primarily damages the intestine, it can affect any organ or tissue in the body.
Celiac disease is not a common disorder, although its prevalence has notably increased in recent decades, which may be related to improvements in research and diagnosis.
Symptoms
The symptoms of celiac disease are highly varied and arise from poor absorption of nutritional components. Common digestive symptoms include:
- Chronic diarrhea
- Weight loss
- Loss of appetite
- Abdominal bloating
- Gas
- Recurrent abdominal pain
- Nausea, vomiting
- Constipation
- Large, fatty stools
- Irritable bowel syndrome
Celiac disease can also present symptoms unrelated to the digestive system:
- Delayed development and growth if it appears in childhood
- Bone and joint pain
- Loss of muscle mass
- Fatigue
- Anemia
- Dermatitis herpetiformis: a skin rash with blisters and itching
- Mouth ulcers
- Headaches
- Changes in mood: irritability, apathy, sadness
- Damage to tooth enamel
Depending on the clinical presentation, different types of celiac disease are distinguished:
- Classic celiac disease: The typical form in children aged 9 to 24 months, characterized by severe malabsorption symptoms and developmental delays.
- Symptomatic celiac disease: Presents with a variety of symptoms, both intestinal and non-intestinal.
- Subclinical or silent celiac disease: No symptoms, but diagnostic tests are positive.
- Latent celiac disease: A complex form of the disease where, at certain times, gluten consumption causes no symptoms and the condition of the intestinal mucosa is normal.
- Type A: The patient was diagnosed with celiac disease in childhood but recovered completely.
- Type B: The patient had normal intestinal mucosa in a previous study and develops the disease later.
- Potential celiac disease: There is a genetic predisposition to develop the disease.
- Refractory celiac disease: Symptoms persist up to six months after starting treatment.
Causes
In people with celiac disease, the ingestion of gluten triggers an abnormal immune system response, releasing different autoantibodies that damage the villi lining the small intestine, responsible for nutrient absorption. These autoantibodies can also attack any other part of the body. The exact cause of gluten intolerance has not been determined, although it is thought to be due to a combination of factors:
- Genetic predisposition: Celiac disease is associated with the HLADQ2 and DQ8 genes. However, having compatible genetics does not always mean the disease will develop.
- Environmental factors, such as intestinal infections caused by reoviruses, early exposure to antibiotics, or digestive stress.
- Other autoimmune diseases caused by the combination of genetics and environmental agents, such as type 1 diabetes, systemic lupus erythematosus, Addison's disease, microscopic colitis, or chronic autoimmune hepatitis.
Risk Factors
The risk of developing celiac disease increases in the following cases:
- Family history
- Autoimmune disorders
- Genetic disorders such as Down syndrome, Williams syndrome, or Turner syndrome
- Gender: it is more common in women
Complications
Nutritional deficiencies caused by impaired absorption function in the intestines can lead to serious consequences in the body. Malabsorption of calcium and vitamin D can cause softening of the bones (osteomalacia or rickets) in children, while in adults, it can result in bone density loss (osteoporosis). A deficiency in vitamin D can also lead to reproductive issues, such as repeated miscarriages, infertility, and congenital malformations in children of untreated mothers. A vitamin K deficiency can cause coagulation disorders. Neurological disorders such as seizures, balance and coordination problems, learning difficulties, or peripheral neuropathy, a disease causing weakness, pain, and numbness in the hands and feet, may also develop.
Furthermore, untreated celiac patients are at higher risk of developing certain types of intestinal cancer, such as lymphoma or adenocarcinoma, as well as other conditions like diabetes, thyroid disorders, lactose intolerance, or dermatitis.
Prevention
There are no preventive measures to avoid gluten intolerance. Therefore, the only way to prevent the development of celiac disease when risk factors are present is to avoid the consumption and exposure to gluten.
Which doctor treats celiac disease?
Celiac disease is evaluated and treated by specialists in gastroenterology and the digestive system.
Diagnosis
Celiac disease is not always easy to diagnose, as its symptoms are also present in other diseases. To confirm celiac disease in patients with characteristic symptoms and risk factors, the following tests are conducted, always before removing gluten from the diet:
- Serological tests: In a blood sample, levels of antibodies against gluten are measured, including anti-gliadin, anti-endomysium, anti-reticulin, and anti-transglutaminase. Elevated levels of these antibodies in the blood indicate celiac disease, although it is not a definitive criterion.
- Genetic studies: The presence of genes associated with celiac disease (HLA DQ2 and DQ8) is checked. Although most people with celiac disease have these genes, the test alone does not confirm the diagnosis.
- Intestinal biopsy: This is the definitive test for establishing the diagnosis. If the serological or genetic test results are positive, a sample of the small intestine's mucosa is taken to check for damage to the villi. The sample is taken through an endoscopy, where a probe (endoscope) with a camera and extraction pincers is inserted through the throat.
Treatment
There is no cure for celiac disease, so the treatment aims to prevent the appearance of symptoms:
- Strict lifelong diet: The complete elimination of gluten from the diet is the only possible treatment for celiac disease. Foods to avoid include those containing any derivative of wheat, barley, oats, rye, spelt, or triticale (a hybrid of wheat and rye):
- Bread
- Flours
- Pastries and baked goods
- Starch
- Semolina
- Pasta
- Chocolate
- Gluten is also used as an additive, so any prepared foods that do not specifically state they are gluten-free should be avoided, such as processed meats, pâtés, sliced cheese, canned foods, sweets, candies, instant coffee and tea, or herbal and nutritional supplements. Gluten may also be found in medications, cosmetics, toothpaste, mouthwashes, adhesives, or modeling clay. Thorough reading of the ingredient labels of every product is essential.
- Nutritional supplements: At the beginning of treatment, it may be necessary to administer vitamins or minerals that are deficient.
- Follow-up: Once the gluten-free diet is initiated, follow-up is required to verify its effect. Improvement in symptoms is usually noticeable within days or weeks, though intestinal recovery may take several years.
- Pharmacological treatment: In cases of refractory celiac disease that does not improve with a gluten-free diet, corticosteroids may be given to help control intestinal inflammation and alleviate symptoms. If this treatment is ineffective, immunosuppressive drugs, such as azathioprine, which inhibit the abnormal immune response, may be used.
