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Celiac disease: symptoms in adults and children, treatment and prognosis

The vast majority of people know almost nothing about celiac disease. Maximum knowledge: celiac disease is the immunity of the gluten-based cereal protein, which is manifested in children. Such judgments are partly wrong.

Celiac disease is different both etiologically and symptomatically from gluten allergy. Meanwhile, gluten enteropathy occurs in one person in a hundred, and 97% of patients are unaware of their illness. Celiac disease in adults is often manifested by symptoms that are attributed to another disease. That is why information about the causes of the disease, its manifestations and treatment is so important.

Gluten (gluten) - a unique vegetable protein that has no analogues. This protein complex is contained in wheat, rye and barley grains. Protein fractions related by properties and composition are also found in oats; they are also actively associated with antibodies to gluten.

In the formation of celiac disease plays an important role anomalous autoimmune reaction. Immune cells perceive gluten protein as aggressive, thus the reaction of synthesis of specific antibodies to it starts. This leads to over-sensitivity and autoimmune failure.

Constant pressure on the immune system leads to exhaustion; already against this background, severe autoimmune diseases and complications that threaten the patient’s life are forming.

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Celiac disease: what is it?

Celiac disease

Do not confuse celiac disease with gluten allergy. The symptoms of these diseases are different, and their development is also fundamentally different. What is it?

Celiac disease is a multifactorial disease resulting in damage to the small intestine by the cel luminous protein. The trigger mechanism of the disease - the use of gluten. It is he who causes immune cells to attack the small intestine, even a few milligrams of gluten is enough for immune aggression.

The disease is manifested not only an atrophic change in the mucous membrane of the small intestine, but also the consequences of impaired absorption. Celiac disease is also called intestinal infantilism, celiac enteropathy, Gi-Herter-Heibner disease, non-toxic sprue.

Stages of celiac disease depending on changes in the intestines:

  • Stage 0 (pre-filtration) - no change in the intestinal mucosa;
  • Stage 1 (infiltrative) - a high number of intraepithelial lymphocytes;
  • Stage 2 (hyperplastic) - deepening of intestinal crypts with preservation of the height of the villi;
  • Stage 3 (destructive) - reversible atrophy of the intestinal villi (first partial, then total);
  • Stage 4 (atrophic) - an irreversible atrophic change in the epithelium of the small intestine, often complicated by oncology.

Celiac disease affects people of different races and ages, the first symptoms of the disease may occur in childhood, and already in the adult period.

Statistical fact: women are susceptible to intestinal infantilism 2 times more often than men.

Modern medicine can not accurately answer the question about the cause of gluten enteropathy. However, there is a clear connection with the following pathological conditions:

  • heredity (HLA genes - DQ8, HLA - DQ2) is a genetically determined violation of gluten splitting, in the presence of celiac disease in a person, the probability of occurrence of the disease in his child is 1:10 and decreases in subsequent generations;
  • allergic factor - sensitization to the gluten peptide gliadin leads to the formation of specific antigens;
  • autoimmune reaction - the presence of gluten peptides in the small intestine causes activation of the immunological reaction against the intestinal epithelium;
  • Adenoviruses - provoke increased sensitivity of the intestinal mucosa to gluten with the simultaneous development of inflammation.

Most often, several factors play a role in the formation of celiac disease. The disease may be preceded by surgery, severe stress, intestinal infection, rheumatoid arthritis.

Glutenenteropathy often accompanies the following diseases:

  • Down syndrome,
  • Type 1 diabetes
  • chronic hepatitis,
  • lymphocytic colitis
  • irritable bowel syndrome.

Forms and symptoms of manifestation

Intestinal infantilism is a “many-sided” pathology, often disguised as other diseases. The following symptomatic forms of celiac disease are distinguished:

  1. Typical - symptoms that indicate intestinal damage predominate;
  2. Hidden - the complete absence of symptoms, it is possible the periodic occurrence of flatulence, diarrhea;
  3. Atypical - clinical manifestations unexpressed with a predominance of symptoms characteristic of diseases of other organs;
  4. Latent - in the complete absence of signs of celiac disease confirm laboratory tests;
  5. Refractory - with sufficiently bright symptoms and positive laboratory data, the anti-gluten diet does not bring even the slightest relief.

Symptoms of Celiac Disease in Adults

Symptoms of Celiac Disease in Adults

Although the disease is primarily associated with damage to the mucosa of the small intestine and the development of atrophy in it, in adults celiac disease manifests unexpressed symptoms from the gastrointestinal tract. An adult suffering from celiac disease may note:

  • intermittent abdominal pain and diarrhea;
  • anemia and weight loss for no apparent reason;
  • unreasonable anxiety and irritability, prolonged depression and sharp mood swings;
  • talking alone with oneself, performing atypical actions for a person, epileptic seizures;
  • chronic fatigue syndrome - dizziness, increased sweating, paroxysmal lack of air, weakness and frequent headache;
  • anemia;
  • female / male infertility, miscarriages;
  • joint and muscle pain (in severe cases, osteoporosis and arthropathy develop, fractures are not uncommon);
  • secondary and immunodeficiency - stomatitis, glossitis, herpetiform dermatitis;
  • multiple caries;
  • constant thirst, every fourth patient develops type 1 diabetes mellitus ;
  • hemorrhages in the abdomen and limbs;
  • intestinal bleeding ( black stools ), in advanced cases lymphoma develops.

Symptoms of celiac disease in children and features of manifestation

Symptoms of Celiac Disease in Children

Symptoms of celiac disease in children are more pronounced, signs of damage to the intestinal tract prevail. For babies up to 2 years, the following manifestations of the disease are characteristic:

  • fetid diarrhea, a large amount of feces from light yellow to gray and greenish;
  • often the detection of blood streaks in fecal masses, mucus and undigested fiber (in the usual analysis of feces undigested fibers and fatty acids are present);
  • characteristic sign - feces does not sink in water and spreads into pieces;
  • nausea, vomiting;
  • weight gain is practically absent or minimal, anorexia is possible;
  • flatulence and a huge bloated belly, especially noticeable against the background of thin arms / legs;
  • tremor of the limbs, psychomotor agitation.

Older children have celiac disease:

  • constipation, alternating diarrhea (almost no normal stool);
  • loss of appetite or, on the contrary, constant hunger;
  • anemia;
  • low weight, low growth;
  • various allergic reactions mi (diathesis, urticaria, pollinosis);
  • osteoporosis, rapid destruction of milk teeth;
  • alopecia;
  • autism.

Diagnosis of celiac disease: analyzes and instrumental studies

For a diagnosis of celiac disease, a single picture of the patient's complaints and diagnostic data is necessary. Indicate the disease:

  • the appearance of the patient - pallor of the skin, problems with height and weight, periodically appearing hemorrhages, etc .;
  • history - patient complaints;
  • improved condition with a gluten-free diet;
  • coprology - a large number of soaps, fatty acids in feces;
  • examination of fecal occult blood ;
  • biochemistry - hypoalbuminemia / hypoproteinemia, low concentration of fats and cholesterol, lack of calcium and phosphates;
  • X-ray - osteoporosis, intestinal dyskinesia and clearly defined horizontal levels in the intestinal loops;
  • Ultrasound of the bones and abdomen;
  • fibrogastroduodenoscopy (carried out before the appointment of a gluten-free diet);
  • biopsy of the mucous membrane of the intestine - assessment of the degree of atrophy of the Marsh system;
  • serological analysis for celiac disease - detection of antigliadin (low sensitivity), anti-reticulin antibodies and IgA to endomysia.

Treatment of celiac disease in adults and children

Treatment of celiac disease in adults and children

The treatment complex for celiac disease in adults, as well as in children, includes drug therapy aimed at eliminating the symptoms of the disease and a lifelong diet.

Drug treatment for celiac enteropathy:

  1. Antidiarrheal drugs;
  2. Avitaminosis control - multivitamin means;
  3. Treatment of anemia - folic acid, Vit. B12, iron preparations;
  4. Bone density restoration - Vit. D, calcium preparations;
  5. According to the appointment of an allergist-immunologist antihistamines, immunocorrectors;
  6. Psychotropic drugs (only by appointment of a psychotherapist!);
  7. In severe cases, corticosteroids and IV infusion of nutrient solutions.

In no case, patients with celiac disease can not take the tablet form of medication. coated (contain gluten), and liquid forms containing malt!

Nutrition for celiac enteropathy

When celiac disease is revealed, it is forbidden for the patient to consume the following products for life:

  • cereals - wheat, barley, rye, oats;
  • all flour products - bread, pasta, biscuits, pastries;
  • products with stabilizers, emulsifiers, dyes, etc .;
  • meat / fish semi-finished products, sausages, sausage, imitation of crab sticks;
  • ice cream, yogurt, mayonnaise, margarine and various pasta;
  • dry soups, bouillon cubes;
  • some types of tea, cocoa drinks, coffee (see composition);
  • kvass, some types of alcohol.

It is necessary to avoid the elementary entry of gluten into the intestines of a patient with celiac disease while cooking through cutting boards, etc.

It is absolutely safe to use:

  • meat, fish, poultry;
  • dairy products and eggs;
  • buckwheat, rice, corn, legumes;
  • fruits and vegetables.

When buying products in the store, it is necessary to read their composition each time, since even when processing some of them (for example, polishing peas), gluten may appear, which is reported on the package.

Forecast

With timely diagnosis of celiac disease and its complex treatment, the prognosis is favorable. Gluten-free diet gives effect after 3 weeks.

However, the restoration of the intestine at the microscopic level (subject to the reversibility of atrophy) occurs after 2-2.5 years of strict diet.

Life expectancy is not reduced, and the restrictions relate exclusively to nutrition. Only in advanced cases are possible complications, often life-threatening:

  1. Ulcerative lesion of the small intestine;
  2. Development of refractory celiac disease;
  3. Infertility ;
  4. Osteoporosis;
  5. Oncology of the intestine, stomach, lymphoma;
  6. Psychological pathology.

Prevention of Celiac Disease

In the presence of gluten enteropathy in relatives, a genetic study of parents to determine the risk of intestinal infantilism in future children.

Regular examination of patients at risk (diabetes, autoimmune diseases, hepatitis, etc.).

Breastfeeding of newborns for at least 4 months. The introduction of gluten with lure no later than 7 months, starting with the minimum dose.

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