Celiac disease, a disease of the immune system, is caused by sensitivity to gluten in food. Celiac disease, which can be seen at any age, is more common in children with a family history of celiac disease.
What is Celiac Disease?
Our immune system produces antibodies to remove pathogens such as viruses and bacteria from the body. This protects the body. However, some people also produce antibodies against non-harmful or even beneficial substances. In celiac disease, these antibodies are produced against a protein called gluten. For this reason, when patients consume foods containing gluten protein, antibodies produced by the body in the small intestine cause celiac disease to develop. In celiac disease, the layer in the small intestine that allows the absorption of nutrients is damaged. These changes in the intestinal mucosa also reduce the absorption of nutrients. In particular, the absorption of important substances such as folic acid and iron is impaired.
Types of Celiac Disease
Symptoms of celiac disease vary according to patients shows. Some patients experience severe symptoms, while others have mild complaints. This is because there are different types of celiac disease.
Classic Celiac Disease
It is a type that usually occurs in children between 6 and 24 months of age when gluten intake begins with additional food. Lactose intolerance and some parasitic diseases should also be investigated in these patients.
Atypical Celiac Disease
Atypical celiac disease usually affects children aged 5-6 years and older and adults. Although the symptoms are mild, non-digestive symptoms are prominent. For this reason, it is extremely difficult to diagnose these patients.
In addition, atypical celiac disease is often confused with irritable bowel syndrome. However, celiac disease should be considered in cases of unexplained iron, folic acid and vitamin B12 deficiency.
Silent Celiac Disease
Silent celiac disease is a type of celiac disease that is diagnosed through family screening, where celiac disease is detected in relatives.
Potential Celiac Disease
Although celiac tests are positive, biopsies of the small intestine show normal or minimal changes. Since these patients may develop celiac disease in later years, regular medical check-ups are necessary.
Non-celiac Gluten Sensitivity
Although these patients cannot tolerate gluten, they have no celiac antibodies and no damage to the small intestinal mucosa. Symptoms of gluten sensitivity, which is seen in approximately 20% of the population, are similar to those of celiac disease, but milder.
Causes of Celiac Disease
The main cause of celiac disease is genetic predisposition. For this reason, the likelihood of celiac disease is increased in people with celiac disease or dermatitis herpetiformis in close relatives.
If gluten is not present in the foods consumed by patients, the disease does not cause any symptoms. For this reason, celiac disease is rare in countries where gluten is consumed less, such as China and Japan.
While the prevalence of celiac disease is 1% in the world, the prevalence in school children between the ages of 6 and 17 is approximately 1.7% in our country.
Symptoms of Celiac Disease
Symptoms of celiac disease vary according to the age group of the patient.
Children Under 2 Years
- Loss of appetite
- Developmental delay,
- Abdominal swelling,
- Chronic diarrhea,
- Vomiting,
Children Over 2 Years
- Attention deficit,
- Hyperactivity disorder,
- Learning difficulties,
- Headache
- Lack of muscle coordination,
- Delayed puberty
- Irritability
- Weight loss,
- Chronic constipation,
- Vomiting,
- Slowing of development,
- Don’t be weaker than your peers,
- Don’t be shorter than your peers,
- Diarrhea that does not go away for several weeks,
Adults
- Tooth enamel problems,
- Skin rashes,
- Infertility
- Mood changes,
- Irritability,
- Depression,
- Liver diseases of unknown cause,
- Headache,
- Iron deficiency,
- Bone and joint pain,
- Weight loss,
- Loss of appetite,
- Gas complaints,
- Abdominal pain
- Cramp,
- Light-colored stool,
- Foul-smelling feces,
- Increased need for toileting,
- Constipation
- Vomiting,
- Diarrhea,
- Anemia,
- Abdominal bloating,
How is Celiac Disease Diagnosed?
Celiac disease is easily diagnosed in children. Because children with celiac disease have persistent vomiting, unexplained abdominal pain, skin rashes, allergies and anemia that does not improve despite treatment. However, when it comes to adults, celiac disease is not easy to diagnose. Because only one of these symptoms is observed.
Serologic tests and small bowel biopsy are used in the diagnosis of celiac disease. Anti-endomysium and antigliadin antibody tests are performed in patients with serologic tests. On the other hand, the tests with the highest sensitivity are Ig A and G tests. These tests are used for both screening and monitoring.
In order to make a definitive diagnosis, the intestinal structure must be evaluated by endoscopy. A sample for biopsy is also taken at this stage. Biopsy samples are usually taken from the beginning of the small intestine, which is the most common site of the disease. However, silent organs should not be forgotten during this process.
Celiac Disease Treatment
Celiac patients need to follow a gluten-free diet throughout their lives. With the complete elimination of gluten during treatment, there is a rapid improvement in the structure of the intestine. On the other hand, patients should be under the control of a dietitian as there are rules to be followed in a gluten-free diet. In the gluten-free diet, a nutrition plan is created in accordance with the mineral and vitamin deficiencies of the patients.
Dietary Considerations for Celiac Patients
The diet of celiac patients excludes foods containing gluten protein such as barley, wheat, rye and oats. In addition to the frequent consumption of rice and corn, vitamins such as B12 need to be replaced.
It is important to educate patients about the gluten-free diet and to motivate them continuously. On the other hand, any deficiencies in folic acid, iron, vitamins A, B12, D, E and K should also be replaced.
