Celiac Disease - Causes, Symptoms and Treatment .MF .
Celiac disease (or gluten enteropathy, Gee's disease, non-tropical sprue, intestinal infantilism, flour disease) - a disease of the intestine, which has a genetic cause and is characterized by intolerance to gluten proteins and chronic inflammation of the small intestine mucosa.
gluten (gluten) - a protein found in cereals (rye, wheat, barley, oats, to a lesser extent).The composition includes a protein L-gliadin - soluble in alcohol glycoprotein that activates autoimmune aggression has a damaging effect on colon mucosa to cause inflammation and atrophic processes and gives the absorption of nutrients in the gut.
Celiac disease occurs at a frequency of 1: 300 - 1: 3700 Women suffer almost twice as often as men.The most common disease in the United States, Northern Ireland, Austria and Italy.
Causes of celiac disease
The cause of celiac disease is not fully understood, identified the main risk factors and launchers.
1. Genetic predisposition - gliadinaminopeptidazy defect enzyme responsible for t
2. Immune disorders (disease significantly more frequently diagnosed in people who already have an autoimmune pathology: type 1 diabetes, rheumatoid arthritis, dermatitis herpetiformis, autoimmune thyroiditis, alopecia, scleroderma, and in patients with hereditary syndromes: Down syndrome, Turnerand Williams).
also a relative risk factor is the presence of other intestinal pathologies (congenital or acquired), as increased cell sensitivity to gluten.
Carriage of genes does not mean the disease, it develops only in some media, and this often requires some additional factors.The trigger factor may be pregnant, current worsening of autoimmune diseases, acute viral infection, stress, surgery on the intestines.
In children the disease appears more often with the introduction of weaning cereals, but may appear later, after 5-6 months after the start of introduction of complementary foods or artificial feeding glyutensoderzhaschimi mixtures, sometimes after suffering acute respiratory viral infection, intestinal infection.In some cases, the first symptoms of the disease appear in the age of 2-3 or even 10 years.Symptoms of celiac disease
When celiac disease affected intestinal mucosa, there is atrophy of the villi of the small intestine, it leads to malabsorption of nutrients from food.These processes and cause all disease symptoms.
Symptoms of celiac disease in children
- weight gain slowed down and does not meet the standards,
- slow growth,
- curvature of the spine,
- frequent regurgitation, vomiting,
- irritability, moodiness, episodes of aggression and apathy, lethargy,
- paroxysmal abdominal pain blunt nature,
- change in stool character (increases the amount it gets frothy, pasty character, shiny look and sharply unpleasant odor),
- chronic or intermittent diarrhea,
- delayed dentition, early caries,
- intolerance to cow's milk,
- secondary immunodeficiency (particularly prone to infectious diseases).
These symptoms can occur individually or in combination.Next, the girls may have problems with the formation of menstrual function, it increases the likelihood of developing polycystic ovaries, sexual dysfunction in males.
Symptoms of celiac disease in adults
- diarrhea to 5-6 times per day, alternating constipation and diarrhea,
- blood in the stool, less abundant admixture of blood, caused by intestinal ulceration with breaking
vessel - chronic anemia, thrombocytopenia, rarely,
- coagulopathy (violation of clotting due to malabsorption of vitamin K),
- bloating and rumbling (flatulence),
- cramping pain in the umbilical region,
- nausea and vomiting,
- weight loss, weakness,
- osteopeniaand osteoporosis (brittle bones),
- frequent caries aphthous (ulcerative) stomatitis,
- skin rash,
- dryness and peeling of the skin,
- reduction in spleen size,
- arthritis without strain,
- gynecological problems (violationmenstruation, amenorrhea),
- hepatitis (liver inflammation), which developed without any objective reason,
- bouts of migraine, drowsiness, and in some cases, seizures, depression, can be observed numbness of hands and feet, panic attacks,
Atypical forms of celiac disease (nephropathy, endocrinopathies) is extremely difficult to diagnose.The latent (hidden), celiac disease occurs almost imperceptibly, with occasional bouts of intestinal disorders for no apparent reason, there is a minor skin rash.Difficult to diagnose and it is dangerous.Diagnosis of celiac disease
Diagnosis is complicated, especially for those that do not think about celiac disease and try to treat the individual symptoms (arthritis, diarrhea, stomatitis).
Begin with a routine examination:
- Complete blood count (UAC may be a decrease in hemoglobin, decrease in red blood cell size), in a detailed analysis of a decrease in T and B lymphocytes (defense cells which are responsible for different types of immunity)
- overall analysisurine (OAM)
- blood chemistry (celiac disease may experience a decrease in cholesterol and protein, glucose intolerance, increased ALT, AST) and vitamin B12 analysis (its number is reduced)
- coagulation (indicators of blood coagulation)
-scatological study: little-designed yellow-brown or gray-yellow stool with undigested food residue microscopically: fatty acids, soaps, the presence of grains of starch and iodophilic flora
- microbiological examination of stool: dysbiosis of various severity, reducing the amount of protective strains of E. coli,growth hemolytic flora, laktonegativnyh enterobacteria, Proteus
- ultrasound of internal organs
can be assigned densitometry (measurement of bone density).
The following is a specific diagnosis:
I stage: combination of 3 major symptoms or 2 main and additional - suspected celiac disease.
II stage - serum: raising antibodies M and G types to gliadin and tissue transglutaminase (ATTG).Antibody levels measured prior to a gluten-free diet.The material is venous blood.
High titers (10-fold excess of the norm or more) indicate a high probability of celiac disease.
The next step is to determine the blood in AEMA (endomysial autoantibodies) and HLA-typing (genetic analysis, genetic typing to search for defective genes).
genes HLA-system responsible for the distinction of their own and other cells in the body and are associated with the immune system.From the whole set of HLA genes available for typing, it has a value of HLA-DQ, now known seven variants of HLA-DQ (DQ2 and DQ4-DQ9).
About 95% of patients with celiac disease are hereditary carriers DQ2 (DQA1 * 0501 varieties, B1 * 0201), or more rarely DQ8 (DQA1 * 0501 varieties or DQB1 * 0201).
These genetic markers are necessary but not sufficient conditions for the development of celiac disease and occur in approximately 30% of the population.Inheritance determines the gene from both parents increases the risk of disease and the development of complications.
reason that these genes to increase the risk of celiac disease is that the increased sensitivity to gliadin and thus the immune system is activated and starts the process of auto-aggressive.
presence of genetic markers for celiac disease identifies high probability of disease, the lack of them - virtually eliminates the risk of the disease.
Genetic testing for the presence of DQ2 / DQ8 should be performed in all patients with suspected celiac disease and blood relatives a man who confirmed this diagnosis (inheritance risk relatives up to 15% depending on the degree of kinship, the twins up to 75%).It is also advisable to carry out genetic typing of persons with the following diseases: insulin-dependent diabetes, hypoglycemic condition of unknown origin (an inexplicable drop in blood sugar), juvenile rheumatoid arthritis, autoimmune thyroid disease, hepatitis of unknown etiology, cardiomyopathy.
however, is not enough data for the introduction of a screening population survey (ie a 100% testing).
positive results of all the tests allow to set the diagnosis of celiac disease, and Phase III is not required.When questionable result shows the transition to the next stage.
III stage - Tool: biopsy (taking a piece of mucosa for microscopic examination) with the identification of mucosal atrophy and characteristic morphological features.
With the technical impossibility of carrying out the second and third phases recommended the appointment of a strictly gluten-free diet for at least 6 months (with a significant reduction vesorostovyh indicators not less than 1 year) with a dynamic observation.With good clinical effect of the abolition of the diet is not shown.
treatment of celiac disease
main treatment for celiac disease is a lifelong appointment strict gluten-free diet.Caloric needs to be twice larger than that of healthy people of the same age group.Also, the principle of mechanical and chemical schazheniya.Eating is done 5-6 times a day.
Compliance lifetime diet - a difficult thing, but observance of several rules can facilitate the process:
- Prepare food at home, so you can reliably control all of the ingredients, if you have to use the cafe / restaurant services, choose only familiar dishes and,cook warned about the problem, ask about the composition of food.Since we are not talking about moods and state of health, you certainly will meet.
- Buy products of proven brands, and carefully read the labels on food labels, there are some "gluten-free" and is an indication of safe products, gluten may be contained in the products, including modified starch, dextrin, hydrolyzed vegetable protein, sauces and condiments.
- Now in many supermarkets have special departments of products for people with celiac disease, diabetes can also try ordering products via the Internet.
- If you are cooking for the family, then you must have separate utensils for cooking and eating the food before cooking thoroughly wipe work surfaces to prevent contamination of wheat flour and other products prohibited for you, keep your food separately in a closed container.
- Drinking alcoholic beverages is permitted in small quantities, are allowed rum, tequila, wine, brandy, gin.
- Some formulations contain gluten, so it is always warn the doctor of any specialty of the disease (in the membrane preparations mezim, festal, komplivit, allohol, novopassita liquid form and the other part of gluten).
- Gluten may be contained in cosmetics, such as lipstick.
excluded in celiac disease: wheat (including semolina and couscous), rye, barley, oats, bread of all kinds, pasta and instant noodles, bakery products (cakes, cookies, wafers, biscuits, drying),ice cream, some yogurts, many cheeses, sausages, canned foods, sauces, ketchup, vinegar, soy sauce, mayonnaise, chocolates with fillings, caramel, some varieties of chocolate, cereal, coffee, tea and cocoa, concentrated soups and bouillon cubes,crab sticks, margarine, breaded dishes, all products with dyes and preservatives, kvass, beer wheat and barley, wheat vodka, whiskey.
prohibited products containing more than 1 mg of gluten per 100 g of product.
allowed in celiac disease: rice, millet, buckwheat porridge (before cooking grits must carefully sort out and wash as possible contamination of wheat under cultivation, storage and transportation), products made from rice, corn flour, soybean and potato starch,fruit, vegetables (including potatoes), vegetable oil, honey, meat, poultry, fish, eggs, low-fat varieties of caviar, tea, weak coffee, herbal teas, broth hips, soups rather weak meat and fish broth.
At the beginning of treatment should be eliminated or severely restrict the use of milk, but further possible extension of the diet and the inclusion of moderate amounts previously prohibited foods.Because dairy products are best digested milk drinks and low-fat cottage cheese.
Drug treatment of celiac disease
- Enzyme preparations (pantsitrat 1-2 capsules 3 times / day with meals, for children older than 6 years of drug use on prescription, the dose is determined individually, at a dose of Creon 10000, 25000, 40000ED, the dose is determined individually, depending on the severity of the condition; pangrol 10000 2-4 capsules with a meal; the duration of the reception of all of these drugs is determined individually).
- Vitamin therapy (vitamins B1 and B6 subcutaneously, nicotinic acid / m or subcutaneously, individual dosages)
- Treatment excess bacterial contamination (microbial colonization) intestine (furazolidone 2 tablets four times a day 5-10 daysintetriks 2 capsules 2 times a day for 10 days under the supervision of the biochemical analysis of blood, such as liver enzymes, meksaza 1-2 pills 3 times a day, up to 2-3 weeks).
- Treatment of dysbiosis (bifikol 3-5 dose 2 times a day, up to 4-6 weeks enterol 1-2 capsules 2 times a day, 7-10 days).
- Treatment of anemia (iron sulfate, ferrous 0.5-1 grams 4-5 times a day after meals, folic acid 5 mg per day for a long time).
- Calcium and vitamin D (selected individually).
- Treatment of depression (treatment selected individually).
- If within 3 months there is no positive response to a gluten-free diet, you should conduct a course of metronidazole (Trichopolum) 1 c.daily 5 days and totally exclude dairy products.
- If there is no further response to diet or treatment is started in severe clinical symptoms, shows the introduction of prednisone 20 mg daily for 7 days.
- Refractory celiac disease needs to be reviewed and possibly treat the appointment of immunosuppressive agents (dose and duration of selected gastroenterologist and strictly monitored during treatment).
Complications of celiac disease
- the development of ulcers of different depths in the intestine, which may occur with intestinal bleeding and perforation of ulcers,
- development of refractory (resistant to any treatment), celiac disease,
- manifestationsall kinds of hypo- and beriberi,
- bone fractures due to osteoporosis,
- higher risk of developing cancer of the intestine disease (lymphoma and small bowel cancer, rarely esophageal cancer, stomach and colon),
- in pregnant women at increased risk of miscarriage, premature birth,low birth weight and children with abnormalities of the nervous system (due to violations of folic acid intake).
Clinical improvement was observed after a few days of special observance of a gluten-free diet, sustained improvement in 3-6 months.With good adherence to a diet relatively favorable prognosis, monitoring the gastroenterologist is required 1-2 times per year.
Forecast worsens with late start of treatment, the development of refractory celiac disease, the formation of complications, requires dynamic monitoring physician and gastroenterologist, consulted other specialists (surgeon, endocrinologist, gynecologist, urologist, rheumatologist, dermatologist).Mortality rates in patients who do not comply with gluten-free diet, make up about 10-30%.On this background diet index becomes less than 1%.
Remember that gluten intolerance is saved over a lifetime.Diet and medication can help only to remove the disturbing symptoms.
In the process of development of a new style of life, you can help a society of people suffering from the same disease, the sites on the internet that specialize in the supply of gluten-free products.
doctor therapist Petrov AV