Celiac enteropathy: treatment and symptoms. Celiac disease - causes, signs, symptoms, treatment of celiac disease. Medical treatment includes

Celiac disease (otherwise celiac disease) is a disease associated with intolerance to the fraction of proteins contained in grains of wheat (gliadin), barley (hordein), rye (secalin) and oats (avenin), which are common name"gluten".

The harmfulness of a protein depends on the structure, that is, on the sequence of amino acids contained in it. When it enters the body, there is an increase in the concentration of certain proteins in the blood, causing damage intestinal mucosa. This leads to atrophy of the intestinal villi and loss of their ability to perform their functions.

celiac disease found in children between 2 and 4 years of age, and sometimes later. It can also develop in adulthood, mainly as a complication after other diseases.

Causes of celiac disease

Toxin Theory

This hypothesis is based on the existence enzymatic disorders, which are responsible for the improper digestion of gluten. In an undegraded form, they have a toxic effect on enterocytes (cells of the intestinal tract).

The immune basis of the disease is indicated by the production of antigliadin bodies by the body (detected in a blood test), as well as the presence in the mucous membrane small intestine lymphocytic edema with a predominance of T cells.

Theory of aggression

This theory sees the cause of the problem in the occurrence of an immune response against the body's own normal cells. In the patient's blood serum, antibodies are detected, for example, IgA-EMA, IgA-ARA, concomitant with other autoaggressive diseases, for example, ulcerative colitis, systemic lupus erythematosus, sarcoidosis.

Theory of Inheritance

AT this case It is assumed that the development of the disease is significantly influenced by genetic predisposition. The existence of a close relationship between celiac disease and the histocompatibility antigens HLA-DR3 and/or DR7, DC3, HLA-B8 has been proven.

Symptoms of celiac disease

Based on the types of disease symptoms that occur, we can divide celiac disease into 3 types: classic, silent and hidden (latent).

Incorrectly treated or late treatment of celiac disease causes symptoms of chronic malnutrition: growth deficiency, delayed bone development, curvature of the spine, hypochromic anemia, atrophic gastritis, rickets, skin changes, delayed puberty, emotional disturbances(irritability, difficulty concentrating, apathy). Classic celiac disease occurs in only 30% of all cases of the disease.

silent celiac disease

Diagnosed in people who do not have underlying clinical symptoms, however, there are typical changes colon found in laboratory tests.

The indications for performing a screening test are:

abdominal pain, bloating, loose stools;
symptoms of somatic developmental delay;
chronic diseases(diabetes mellitus type 1), diseases thyroid gland, tooth enamel hypoplasia, mouth ulcers (aphthae), which often progress, mental disorders(eg, schizophrenia), tumors of the small intestine, mainly lymphoma.

Hidden celiac disease

The disease potentially exists, but there are no clinical symptoms or changes in the small intestine. Certain circumstances, such as, for example, infections of the gastrointestinal tract, surgical procedures, pregnancy, stress, increased consumption of gluten, can lead to the onset of symptoms and disclosure of the disease.

Diagnosis and treatment of celiac disease

anti-reticulin antibodies (ARA) in the IgA and IgG class;
antigliadin bodies (AGA) of the IgA and IgG classes;
antibodies against endomysium (EMA) in the class of IgA and IgG;
IgA antibodies against tissue transglutaminase.

The actual amount...

A form of treatment is the use of a gluten-free diet. Its introduction into life causes the regeneration of intestinal villi, and, consequently, the weakening of adverse clinical symptoms.

In children who are observed acute process diseases, sometimes in the first stage of treatment, it is also necessary to use also dairy-free, hypoallergenic diet. Gluten-free foods include: rice, soy, corn, millet, and wheat starch.

Patients with gluten enteropathy exhibit individual gluten intolerance, which depends on the age, stage of the disease and the dose of gluten. Children are the most sensitive. A gluten-free diet should be followed throughout life.

GLUTEN DISEASE(syn.: celiac disease, gluten enteropathy, gluten-sensitive celiac disease, idiopathic celiac disease) - a disease caused by intolerance to one of the main parts of the protein cereal plants- gluten, and due to congenital or acquired deficiency of one of the enzymes of intestinal juice.

G. b. isolated as an independent disease large group patol. conditions, united under the term "celiac disease" and representing a manifestation enzyme deficiency. Unlike other forms of celiac disease (see), observed mainly in children, G. b. occurs often in adults, sometimes combined with disaccharidase deficiency, manifested by milk intolerance (see Malabsorption syndrome).

For the first time, the harmful effect of gluten was established by Dicke, Weijers, Van de Kamer (W. Dicke, H. Weijers, J. Van de Kamer) in 1950. Gluten consists of two fractions - glutenin and gliadin, of which only the latter contributes to the manifestation of G b. The reason for the damaging effect of this protein fraction and the mechanism of G.'s development. are not yet completely clear. damaging factor in pure form not highlighted.

Pathogenesis

The pathogenesis of the disease is complex. Discussed various reasons contributing to the development of the disease, but their role remains hypothetical. The leading pathogenetic significance is the deficiency of a specific enzyme from the peptidase-aminopeptidase group contained in intestinal juice and cleaving gliadin to a water-soluble peptide fraction (fraction 3). This peptide fraction, keeping the damaging effect of gliadin, causes G.. It is proved that patol, the action of gliadin and peptide fraction disappears when they are incubated with an extract of the mucous membrane of the small intestine of a pig. The neutralizing effect is attributed to the enzyme gliadinamidase contained in the mucous membrane of the small intestine of the pig. It is known that the mucosa of the small intestine healthy person also has the ability to cleave the peptide fraction to its constituent amino acids; mucous membrane of the patient G. b. deprived of this ability. With a deficiency of specific enzymes, products of incomplete breakdown of gluten are absorbed, which determines the toxic effect.

In G.'s development. an important role is played by the state of hypersensitization, which occurs in response to the introduction of gluten and some of its fractions into the body. extreme allergic reactions such patients is the so-called. gliadin shock. Confirmation immunol, G.'s theory of pathogenesis. is a decrease in the titer of complement-fixing antibodies to rye and wheat proteins in response to a gluten food test (gliadinotolerance test) and the presence in the serum of patients with antibodies to the peptide fraction, which decrease when a gluten-free diet is observed. Also accumulation at G. testifies to a hypersensitization. a large number plasma cells in the contents of the small intestine and a decrease in their number on the background of a gluten-free diet. The role of immunol, the factor is confirmed by the appearance in the feces of patients with specific antibodies - coproantibodies, immunologically competent cells, the formation of which is associated with the production of antibodies in the very small intestine in response to the introduction of gluten. Great importance has detection in the secret of the proximal jejunum of immunoglobulins. In the plasma cells of the intestine, the concentration of IgA is very high, much less IgM and very little IgG.

Pathological changes

Pathological and anatomical changes in G. b. differ little from changes in other forms of celiac disease and consist in atrophy of the villi of the small intestine, accompanied by a decrease in the activity of specific peptidases in the membranes brush border. Pronounced infiltration of the intestinal mucosa by plasma cells. Patol, the process is more intense in the proximal part of the small intestine, which is obviously associated with the direct impact of the damaging agent - the digestion and absorption of gluten in this section of the intestines.

Clinical picture

Characterized by persistent diarrhea with polyfecal matter, steatorrhea (see), flatulence (see); with the progression of the disease - a disorder metabolic processes(exhaustion, hypoproteinemia, hypovitaminosis, anemia, mineral and water-salt metabolism) due to intestinal malabsorption. In far-reaching cases, changes in the psyche occur, children have a developmental lag.

Diagnosis

Accurate and direct methods of diagnosis of G. b. no. Indirect methods include gliadinotolerance test - a test with a load of gliadin (350 mg of gliadin per 1 kg of weight): taking gliadin causes a significant increase in the level of glutamine in the blood in patients. However, this test cannot be considered sufficiently reliable.

Most persuasive diagnostic sign G. b. - the disappearance of all symptoms when following a gluten-free diet and the occurrence of a relapse when eating products containing gluten.

Treatment

The only effective treatment is the appointment of a gluten-free diet for long periods (months, years). Gluten-free breads and bread products made from gluten-free wheat starch are recommended. The diet should be complete in composition, mechanically and chemically sparing.

With the development of the syndrome of impaired absorption, the amount of animal protein in the diet is increased, according to indications, protein preparations and vitamins are administered parenterally.

Forecast

A complete cure is possible, apparently, only in cases of acquired gluten enzymopathies, when the use of a gluten-free diet helps to restore the architectonics of the small intestine and its enzymatic activity.

Bibliography: Beyul E. A. and Ekisenina N. I. Chronic enteritis and colitis (Issues of pathogenesis, clinics and treatment), p. 164, M., 1975; Handbook of gastroenterology, ed. V. X. Vasilenko, p. 95, Moscow, 1976; Tashev T. A. et al. Diseases of the stomach, intestines and peritoneum, trans. from Bulgarian, p. 461, Sofia, 1964; Frolkis A. V. Functional diagnosis of intestinal diseases, p. 28, M., 1973; D i s s a n a y a k e A. S. a. about. Identifying toxic fractions of wheat gluten and their effect on the jejunal mucosa in coeliac disease, Gut, v. 15, p. 931, 1974, bibliogr.; F a 1 with h u k Z. M. a. S t r o-b e r W. Gluten-sensitive enteropathy, ibid., p. 947, bibliogr.; K a m e r J. H. a. ,W e i ] e r s H. A, Malabsorption syndrome. Fed. Proc., v. 20, p. 335, 1961.

In recent years, such atypical pathology as celiac disease has become widespread. the body's immune response to eating gluten, a protein found in wheat, barley, and rye.

In celiac disease (celiac disease), the use of this protein causes an inadequate response of a fragment of the immune system located in the small intestine. Over time, the pathological reaction leads to an inflammatory process that damages the lining of the small intestine and disrupts the absorption of a number of nutrients (malabsorption).

Damage to the small intestine, in turn, leads to weight loss, bloating, and diarrhea. Gradually, the body begins to lack the necessary for normal life, and then the brain, nervous system, bones, liver and other internal organs suffer.

Children have celiac disease (photos showing it external signs, published in medical journals) often causes growth and developmental delay. Irritation in the intestines can cause abdominal pain, especially after eating.

Celiac disease is incurable, but subject to strict diet her symptoms can be alleviated.

Symptoms

The signs and symptoms of the disease in question are very diverse, as they completely depend on individual characteristics the patient's body.

Although weight loss and indigestion are considered standard signs of celiac disease, many patients do not experience any discomfort associated with the functioning of the gastrointestinal tract. Only a third of patients suffer from chronic diarrhea, and only half of the respondents complain of weight loss.

Approximately 20% of patients, on the contrary, suffer from chronic constipation; 10% - from obesity (although some scientists believe that these disorders are not caused by celiac disease at all). Non-digestive symptoms can be grouped into the following list:

anemia (usually due to iron deficiency);
osteoporosis (dystrophy bone tissue) or osteomalacia (softening of the bones);
skin rash in the form of itchy blisters (dermatosis herpetiformis);
damage to tooth enamel;
headaches, feeling tired;
damage nervous system, including numbness and tingling in the feet and hands, as well as possible difficulty in maintaining balance;
pain in the ligaments;
decreased function of the spleen (hyposplenia);
acid reflux and heartburn.

Celiac disease: symptoms in children

More than 75% of children with celiac disease are overweight or obese. Signs of pathology associated with the functioning of the gastrointestinal tract occur in 20-30% of young patients. It is almost impossible to obtain more accurate data, since the symptomatology depends primarily on the age of the patient.

Typical signs of celiac disease in newborns:

chronic diarrhea;
bloating;
pain;
lag in physical development, bad feeling, weight loss.

Older children who are diagnosed with celiac disease may experience the following symptoms:

diarrhea;
constipation;
low growth;
delayed puberty;
neurological disorders, including attention deficit hyperactivity disorder, learning disabilities, headaches, lack of muscle coordination.

When to See a Doctor

Make an appointment with a specialist if indigestion or abdominal discomfort does not go away within two weeks. Be sure to contact your pediatrician if you notice that the child has become pale, irritable, has stopped gaining weight and growing. warning signs also are bloating and hard, bad-smelling stools.

You should consult with a specialist before going on a gluten-free diet. If you eliminate wheat protein from your diet before your scheduled tests, the test results are likely to be erroneous.

Celiac disease is often passed down from generation to generation. If one of your relatives is diagnosed with a pathology, it will not be superfluous to undergo an examination yourself. In addition, those people whose relatives suffer from diabetes are also at risk.

The reasons

Although in modern world many people know what celiac disease is, the causes of its occurrence and development are still a mystery to scientists.

When the body's immune system overreacts to gluten in food, it damages the tiny, hair-like projections on the mucous membrane (villi). The villi on the shell are responsible for the absorption of vitamins, minerals and other nutrients from the food consumed. Under a microscope, they look like thick pile of soft carpet. For damage caused by celiac disease, inner surface the small intestine begins to remind its appearance more like a tiled floor. As a result, the body is unable to absorb the nutrients it needs to grow and maintain health.

According to a study by the National Institutes of Health in the United States, approximately one in 140 Americans surveyed suffers from celiac disease. On the other hand, many patients for a long time do not go to the doctor and therefore do not even suspect the presence of pathology. Most often, celiac disease affects representatives of the Caucasian race.

Some studies have shown that certain gene changes (mutations) increase the risk of developing celiac disease. However, the presence of such mutations does not mean that a person will necessarily get sick.

In some cases, the pathology first manifests itself after a surgical operation, pregnancy, childbirth, a dangerous viral infection, or severe emotional overload.

Risk factors

Celiac disease can develop in any organism. However, there are circumstances that increase the risk of developing pathology, including:

having a close relative with celiac disease or dermatosis herpetiformis;
diabetes 1 type;
Down syndrome or Turner syndrome;
autoimmune thyroiditis;
microscopic colitis (lymphocytic or collagenous colitis).

Complications

In the absence of treatment or non-compliance with the prescribed therapy, including diet, celiac disease can lead to the following complications:

Wasting due to malnutrition. Damage to the small intestine leads to a violation of the absorption of trace elements necessary for the body. Nutrient deficiencies can cause anemia and weight loss. In children, it leads to a delay in growth and development.
Calcium loss and osteoporosis. A lack of calcium and vitamin D can cause bone softening in children (osteomalacia) or bone degeneration in adults (osteoporosis).
Infertility and miscarriages. The lack of calcium and vitamin D exacerbates the existing violations of the reproductive function.
Lactose intolerance. Damage to the small intestine causes abdominal pain and diarrhea after eating dairy products that contain lactose, even if they do not contain gluten. After therapeutic diet When the intestines are completely healed, lactose intolerance may go away on its own, but doctors do not give any guarantees: some patients have problems digesting dairy products even after they have completed a course of treatment for celiac disease.
Crayfish. The key to fighting the scourge of celiac disease is a diet based on foods free of harmful protein. If you do not follow the diet and other doctor's instructions, the risk of several types of cancer increases, including intestinal lymphoma and cancer of the small intestine.

Diagnostics

To determine celiac disease, the following studies and procedures are carried out:

Blood tests. Enhanced Level certain substances in the blood (antibodies) indicate an immune response to gluten. According to these analyzes, pathology can be detected even in cases where its symptoms practically do not cause discomfort or are completely absent.
Endoscopy. If a patient's blood tests reveal celiac disease, the diagnosis will be complemented by a procedure called "endoscopy", as the doctor will need to examine the small intestine and take a small piece of tissue by biopsy. On the laboratory research specialists will determine whether the villi of the mucous membrane are damaged.
capsule endoscopy. Capsule endoscopy uses a tiny, wireless camera that takes pictures of the patient's entire small intestine. The camera is placed in a capsule the size of a vitamin pill, after which the patient swallows it. As it moves through the gastrointestinal tract, the camera takes thousands of photographs, which are transferred to a recorder.

It is very important to first pass all the prescribed tests for the detection of celiac disease and only after that go on a gluten-free diet. If you eliminate this protein from your diet before you get tested, your test results may appear normal.

Treatment

The only way that celiac disease can be alleviated is through treatment in the form of a gluten-free diet. It should be borne in mind that the harmful protein is found not only in ordinary wheat. They are also rich in the following foods:

barley;
bulgur;
durum;
semolina;
the torment of sin;
malt;
rye;
semolina (krupchatka);
spelled;
triticale (a hybrid of wheat and rye).

Your doctor will likely refer you to a dietitian for joint planning of an optimal gluten-free diet.

As soon as this vegetable protein is eliminated from the diet, the inflammatory process in the small intestine will gradually begin to subside. Improvement can be noticed after two to three weeks, although many patients notice a significant improvement in well-being after a few days. Complete healing and overgrowing of the villi can take from several months to several years. Recovery of the small intestine is faster in young children than in adults.

If you accidentally eat a product that contains gluten, you may experience symptoms such as abdominal pain and diarrhea. Some people have no symptoms at all, but this does not mean that wheat protein is completely harmless to them. Carefully read the composition of the products indicated on the package: even traces of gluten can cause damage, regardless of the presence or absence of signs of the disease.

Vitamin and mineral supplements

Diagnosis "gluten disease" - what does it mean? First of all, it is necessary to avoid any dishes containing wheat, barley, rye and their derivatives. Reducing the amount of cereals consumed can lead to nutritional deficiencies - in this case, a therapist or nutritionist will recommend taking vitamin and mineral supplements. nutritional supplements to compensate for the lack of appropriate substances in the diet. To such vital essential substances relate:

calcium;
folic acid;
iron;
vitamin B-12;
vitamin D;
vitamin K;
zinc.

Vitamin supplements are usually taken in tablet form. If you are diagnosed serious violations absorption of nutrients, the doctor will prescribe vitamins in the form of injections.

Inflammation in the intestines

If the small intestine is severely damaged, the doctor will recommend steroid drugs to suppress the inflammatory process. Steroids can relieve most severe signs pathology and create fertile ground for the healing of damaged intestinal mucosa.

Dangerous products

If you are at risk for celiac disease, prevention should be one of your personal priorities. Avoid prepared food in packages, if the packs or bags do not contain the inscription "does not contain gluten". Malicious protein is found not only in obvious dishes like bakery products, cakes, pies and cookies. It may also be part of following products supply:

beer;
sweets;
sauces;
soy meat or seafood;
processed meat rolls;
salad dressings, including soy sauce;
poultry that does not require fat when fried;
ready-made soups.

Certain grains, such as oats, may contain traces of gluten because they are grown and processed in the same area and on the same equipment as wheat. Science still doesn't know for sure whether oats exacerbate celiac disease in adults, but doctors generally recommend avoiding oatmeal and cereals unless the product says gluten-free on the package. In some cases, even pure cereals without any traces of wheat lead to an aggravation of the inflammatory process in the small intestine.

Approved Products

Almost all the usual food fits the conditions of a gluten-free diet. You can safely eat the following foods:

fresh meat, fish and poultry without breading, adding dough or marinade;
fruit;
most dairy products;
potatoes and other vegetables;
wine and distilled liquids, alcoholic and fruit soft drinks.

Of the cereals on a gluten-free diet, the following are acceptable:

amaranth;
arrowroot;
buckwheat;
corn;
polenta;
any type of flour that does not contain gluten (rice, soy, corn, potato, peas);
quinoa (quinoa);
tapioca.

Fortunately for celiac lovers of baked goods and pasta, over time, many manufacturers produce all more products with a special label "gluten-free". If you can't find these items at your local bakery or grocery store, check out the range of online stores. Many gluten-containing foods and dishes have safe and affordable gluten-free counterparts.

Celiac disease (gluten enteropathy) is a disease of the small intestine, manifested by atrophy of the mucous membrane in response to the introduction of gluten. The prevalence of gluten enetropathy varies greatly in different geographic areas. With the highest frequency, the disease occurs in European countries (1-3:1000), with a lower frequency in African. It is believed that at least 1% of the world's population suffers from this disease. Gluten enteropathy is more often registered among women.

The defeat of the small intestine in celiac disease occurs under the influence of gluten, a protein found in cereals. Gluten consists of several components: prolamine, glutenin, albumin, globulin. It is prolamine that has a damaging effect on the intestinal mucosa. Its amount in different cereals is not the same. So, millet, rye, wheat contain this protein in large quantities. In a smaller amount, prolamine is found in barley, oats, and corn. Prolamin is heterogeneous in its structure, wheat prolamin is called gliadin, barley - hordein, and oat - avein.

A key factor in the development of the disease is a genetic predisposition. In people with this feature, when gluten comes into contact with the intestinal villi, specific antibodies are produced. This is how autoimmune inflammation of the intestinal tissues develops, leading to gradual atrophy of the mucous membrane of the organ.

Villous atrophy that develops in celiac disease dystrophic changes enterocytes lead to a decrease in the absorption surface of the small intestine. As a result, the absorption of proteins, fats, carbohydrates, vitamins, and minerals is disrupted. These changes lead to the appearance of characteristic clinical symptoms. Celiac disease can occur in three forms: classic, atypical, latent.

Celiac disease occurs predominantly in childhood. Children are stunted, noted muscle weakness, apathy, an increase in the size of the abdomen, steatorrhea, spastic pain in the abdomen. Babies are emotionally labile, get tired quickly. But in some patients, the disease manifests itself not from childhood, but already in adulthood.

In general, classic celiac disease is characterized by the following symptoms:

Decrease in body weight (from 5 to 30 kg);
Decreased appetite;
Weakness, fatigue;
Stomach ache;
Dyspeptic symptoms: flatulence, nausea,;
swelling;
Glossitis, ;
Iron deficiency;
Hypocalcemia with osteoporosis;
Hypovitaminosis.

The most constant symptom of celiac disease is recurrent diarrhea, their frequency can reach ten or more times a day. The stool is mushy, light, liquid, frothy.

Constant, severe abdominal pain is not typical for celiac disease. However, patients with celiac disease may experience cramping abdominal pain before or after a bowel movement. And with flatulence there are dull diffuse pains.

When examining a person with celiac disease, an increase in the abdomen attracts attention.

Symptoms of atypical celiac disease

In most cases, celiac disease is atypical. AT clinical picture diseases may be absent or mild gastroenterological symptoms. Extraintestinal symptoms come to the fore:

Anemia;
Ulcerative stomatitis;
, frequent fractures;
Dermatitis herpetiformis (characterized by the appearance of itchy papulo-vesicular rashes on the elbows and buttocks);
hemorrhagic syndrome;
Associated autoimmune diseases (autoimmune thyroiditis, diabetes mellitus, Addison's disease);
Damage to the nervous system (, ataxia, epilepsy, polyneuropathy);
Deterioration of potency, violation of menstruation,.

If left untreated, celiac disease can develop complications. The most common complications include:

malignancy;
Chronic non-granulomatous ulcerative jejunoileitis and colitis;
Neuropathy.

In patients with celiac disease, they develop much more often than in the general population. In addition, cancer of the esophagus, stomach, and rectum is more common. Unreasonable deterioration of the patient's condition, as well as laboratory indicators, despite following a gluten-free diet, should prompt the thought of likely development malignant process.

Chronic non-granulomatous ulcerative jejunoileitis and colitis is characterized by the appearance on the mucous membrane of the jejunum, ileum, colon ulcer defects. Ulcers may bleed or perforate.

Neuropathy manifests itself in the form of numbness, tingling, weakness in lower limbs. Defeat nerve fibers upper limbs observed less frequently. With damage to the cranial nerves, diplopia, dysphonia, dysarthria are observed.

Diagnostics

Symptoms of celiac disease are so diverse and non-specific that certain studies should be carried out to confirm the alleged diagnosis. Since a key factor in the occurrence of celiac disease is a genetic predisposition, a family history of gluten intolerance should be investigated.

The main diagnostic method is serological. In patients with celiac enteropathy, specific antibodies are determined in the blood:

Antigliadin (AGA IgG, IgM);
Endomysial (EMA IgA);
Antibodies to tissue transglutaminase (tTG).

No less important diagnostic method is morphological study mucosa of the small intestine. Endoscopy and histological examination of the intestinal tissue reveals signs of atrophic lesions of the mucous membrane with shortening of the villi, lengthening of the intestinal crypts.

Additional research methods:

- anemia is determined;
- hypoproteinemia, hypocalcemia, hypokalemia, hypomagnesemia are determined;
Coprological examination - a large amount of fat and soaps is determined.

Treatment

Celiac disease is a disease that can be corrected with diet. If the diet is followed, the mucous membrane of the small intestine is restored and soon the person ceases to be disturbed unpleasant symptoms illness.

Diet guidelines for celiac disease:

Exclusion of gluten-containing products from the diet (bread, pasta and confectionery);
Mechanical and thermal sparing digestive tract(dishes are steamed or boiled, used pureed or without grinding);
Exclusion of products that enhance fermentation (milk, legumes);
Limitation of products that stimulate the secretion of the pancreas and stomach (rich meat broths, fat meat).

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With an exacerbation of the disease, in addition to a gluten-free diet, drug treatment is carried out in order to eliminate metabolic disorders. The following groups of drugs are used:

Gluten-sensitive celiac disease, or celiac disease, is an immune-dependent inflammation of the lining of the small intestine in people with a genetic (congenital) sensitivity to gluten. It is found in wheat, rye and barley. Gluten enteropathy leads to the development of hyperregenerative atrophy of the mucous membrane of the small intestine, which gradually disappears only if these cereals are excluded from the diet. Extremely rare, but there are forms of enteropathy sensitive to other proteins (soy protein, rice, chicken eggs, tuna, turkey, etc.).

Symptoms of celiac disease

Developing partial, and in some patients even subtotal (almost complete) atrophy of the villi of the intestinal mucosa, deep degenerative changes in enterocytes (intestinal cells) lead to disruption of intestinal digestion and absorption. Early symptoms of celiac disease appear in childhood, but sometimes the disease can be subclinical for a long time and manifest itself for the first time in adults or even the elderly. Enteropathy is a single disease of children and adults. In women, celiac disease occurs approximately 3-4 times more often than in men.

Symptoms of celiac disease in adults are often blurred. Disease long time may be limited to vague abdominal pain, bloating, occasional diarrhea, and increased fatigue. In typical cases, gluten enteropathy is characterized by diarrhea with polyfaeces and steatorrhea, the development of severe malabsorption syndrome.

Clinical signs of enteropathy

Diarrhea as a permanent symptom of celiac disease. The frequency of stools can be from 2 to 10 times a day or more, as in daytime, as well as at night. Even with a small frequency of bowel movements, there is significant polyfecal matter. In most cases, the stool is clayey, putty-like, light, liquid, and frothy.

Frequent symptom in the diagnosis of celiac enteropathy - bloating, increasing in the evening. May be observed dull pain diffuse character in all parts of the abdomen, associated with bloating. Clinically, the syndrome of impaired absorption is characterized by a violation of the general condition and such symptoms: weakness, decreased performance up to its permanent loss, progressive weight loss. Weight loss can range from 5 to 30 kg.

If celiac disease began in childhood, patients are lagging behind in growth and physical development.

Forms of the disease gluten enteropathy

There are several clinical forms or variants of the disease.

Typical gluten enteropathy characterized by:

development of the disease in early childhood
diarrhea with polyfaeces and steatorrhea,
anemia
metabolic disorders inherent in severe malabsorption syndrome.

Latent gluten enteropathy The disease proceeds subclinically for a long time and first manifests itself in adulthood or even in old age. A careful study of the anamnesis reveals that in childhood, patients lagged behind in physical development, often they had reduced hemoglobin or mild signs of hypovitaminosis (cracks in the corners of the mouth, glossitis, etc.). From the moment the first symptoms of the disease appear, the clinical picture may be similar to that of a typical or asymptomatic form.

Torpid (refractory) celiac disease disease is characterized severe course, no effect from conventional treatment, in connection with which there is a need for the use of glucocorticoid hormones.

Atypical gluten enteropathy. The clinical syndromes noted with it are relatively rare, and the clinical picture of the disease is dominated by extraintestinal symptoms due to malabsorption (anemia, hemorrhages, osteoporosis) or immune disorders(allergies, autoimmune thyroiditis, type 1 diabetes mellitus, Sjögren's syndrome - dryness of all mucous membranes - etc.).

Asymptomatic gluten enteropathy The disease is characterized by the absence of clinical symptoms of the disease. Diagnosed during extensive epidemiological surveys of risk groups and can be of two options:

latent celiac disease: there are no symptoms of malabsorption, but the intestinal mucosa with characteristic signs of hyperregenerative atrophy and (or) an increased number of interepithelial lymphocytes (IELs);

potential (probable) gluten enteropathy.

The second form of predisease is typical for those who have a normal intestinal mucosa, there are no symptoms of impaired absorption, but the risk of GEP disease is very high.

Complications in the diagnosis of gluten enteropathy

Patients are 40 to 100 times more likely than the general population to develop lymphoma and cancer. Cancer of the esophagus, pharynx, stomach and rectum is also diagnosed more often. In general, malignant neoplasms cause the death of about half of patients with untreated celiac disease. Unmotivated deterioration in the condition of patients and a number of laboratory parameters with strict adherence to a gluten-free diet are the basis for the assumption of a complication of the disease celiac enteropathy malignant neoplasm. The possibility of developing lymphoma must be foreseen in each case of torpid course of celiac disease, that is, in the absence of the effect of long-term treatment, despite strict observance diets.

Currently, there are a number of diseases that are genetically and autoimmune associated with celiac disease.

Diseases genetically associated with enteropathy: dermatitis herpetiformis Dühring, recurrent aphthous stomatitis and hypogammaglobulinemia, Down syndrome, autism, schizophrenia.

Autoimmune diseases associated with celiac disease: insulin-dependent diabetes mellitus, autoimmune thyroiditis, primary biliary cirrhosis, autoimmune hepatitis, Sjögren's syndrome, rheumatoid arthritis, vasculitis, systemic lupus erythematosus, recurrent pericarditis, fibrous alveolitis, polymyositis, dementia, etc.

Diagnosis of celiac disease

The problem is of general medical importance. Active detection of celiac disease not only makes it possible to cure these patients, but also aims to primary prevention osteoporosis, anemia, infertility, type 1 diabetes, autoimmune and oncological diseases.

The introduction of immunological methods for diagnosing a disease into clinical practice has changed the traditional ideas about it as a rare disease. Epidemiological screening (rapid) studies based on the detection of antibodies to gliadin, endomysium and tissue transglutaminase show that symptoms of celiac disease occur hundreds of times more often in risk groups than in the general population. This prevalence is explained by an increase in the proportion of latent, asymptomatic forms. At the same time, obvious symptoms of celiac disease (diarrhea, steatorrhea, malnutrition, anemia, hypoproteinemia, etc.) may be absent for a long time. As a result, patients long years, and often for the rest of their lives are deprived of the opportunity to receive adequate treatment gluten enteropathy.

It should be noted that in this disease there is no direct relationship between the consumption of bread and cereals and the nature of the stool, so patients never associate the development of the disease with intolerance to bread. The damaging effect of gluten can only be detected by the degree of atrophy of the small intestine mucosa and its reduction with careful dieting.

In recent decades, the doctrine of the disease has stepped forward. There have been some very significant changes. Immunological diagnostic methods have been introduced into clinical practice, which has changed the traditional view of celiac disease as a rare disease. According to epidemiological studies conducted in large scientific centers Europe and the USA, it was found that from 1 to 3% of the population have antibodies to gluten fractions (cereal protein), as well as to the own tissues of the small intestine (endomysium) and the enzyme (tissue transglutaminase), which are markers of gluten enteropathy. In the vast majority of patients, the presence of symptoms of celiac disease is confirmed by histological examination of the small intestine mucosa. However, the disease in them, as a rule, proceeds without malnutrition, diarrhea, other intestinal symptoms and a detailed picture of the syndrome of impaired absorption, and in an asymptomatic, erased or asymptomatic form, it manifests itself as selective malabsorption (anemia, osteoporosis, amenorrhea, etc.) or autoimmune disorders (thyroiditis, diabetes mellitus, infertility).

The Scientific Society of Gastroenterologists of Russia at its regular V Congress on February 6, 2005 adopted the following resolution on this issue on the active detection of the disease.

Patients with chronic diarrhea, malnutrition, and other clinical symptoms of celiac disease should be given a biopsy of the mucosa of the post-bulb duodenum.

Patients suffering from systemic osteoporosis complicated by bone pain and fractures, iron deficiency anemia unknown etiology, primary infertility, autoimmune thyroiditis, it is recommended to investigate antibodies in the blood serum.

Patients over 18 years of age with suspected symptoms of celiac disease and those with antibody titers of 30 IU/mL and above should be referred for a consultation with a gastroenterologist for histological confirmation of the diagnosis. Residents in Moscow are recommended to be sent to the Central Research Institute of Gastroenterology.

If the diagnosis of celiac disease is confirmed, the patient should be recommended a life-long exclusion from the diet of foods containing gluten and observation by a gastroenterologist.

In cases of autoimmune processes, allergies of unknown etiology or detection of allergens to cereals and soy, it is recommended to investigate antibodies to gliadin in the blood serum.

Treatment of celiac disease

The main method of therapy is a strict lifelong adherence to a gluten-free (grain-free) diet. However, therapy various forms celiac disease has its own characteristics. With an erased, asymptomatic course of the disease, along with the apotene diet, the treatment of gluten enteropathy is carried out with multivitamins, periodic courses of enzymatic and choleretic preparations.

In the presence of diarrhea and malabsorption syndrome, a gluten-free diet is used in a set of measures aimed at correcting metabolic disorders and treating chronic diarrhea. In severe malabsorption syndrome, torpid form of the disease in complex therapy include corticosteroids.

Treatment of celiac disease

With a gluten-free diet, wheat, rye, and barley are completely excluded from the diet. It is allowed to consume up to 60g of oats per day. Long-term follow-up of patients with GEP shows that clinical remission is more stable in those who strictly adhere to a gluten-free diet than in those who violate it.

In the group of patients with a diagnosis of celiac enteropathy, who do not strictly follow a gluten-free diet, that is, occasionally consume a few bread products, there is a pronounced tendency to exacerbate diarrhea with polyfecal matter, weakness, symptoms of hypopolyvitaminosis, and calcium deficiency persist for a long time.

With long-term adherence to a gluten-free diet, the concentration of antigliadin and antiendomysial antibodies in IgA significantly decreases, down to threshold values. In patients who have ceased to follow the diet, the content of antigliadin and antiendomysial antibodies increases sharply even before the appearance of clinical symptoms of a relapse of the disease.

With strict adherence to a gluten-free diet, after 6-12 months, in some patients with a diagnosis of celiac enteropathy, the normal structure of the mucous membrane of the small intestine is restored. In the rest, the villi remain atrophied, but the height of the epithelium clearly increases in all cases. Thus, the main method of rehabilitation therapy for patients suffering from GEP is strict adherence to a gluten-free diet throughout life.

Treatment of celiac disease is considered successful if:

stable clinical remission;

reduction to threshold values of the concentration of antigliadin, antiendomysial antibodies, antibodies to tissue transglutaminase;

restoration of the morphological structure of the mucous membrane of the small intestine.

Treatment of celiac disease by lifelong adherence to a gluten-free diet leads to recovery. The use of a diet in autoimmune diseases associated with celiac disease significantly improves treatment outcomes.

If a gluten-free diet is followed, diarrhea stops, weight gain, an increase in hemoglobin and red blood cells in the blood are noted. The mineralization of bone tissue gradually increases and autoimmune disorders, allergies associated with celiac disease decrease or completely disappear. It also reduces the incidence of oncological diseases, the risk of which in patients with HEP is 100–200 times higher than in the general population.

Clinical example of successful therapy in the diagnosis of celiac disease

A.K.P., aged 60. Anamnesis. Diseases of the gastrointestinal tract manifested throughout life. The last 10 years have seen a significant deterioration. The patient was examined in local and foreign clinics. Three years ago in England, hemorrhoids were operated on in serious condition, a part of the sphincter was operated on. Complaints at the present time: diarrhea alternating with constipation, indigestion, clayey stools, sometimes frothy, abdominal pain, swelling, weakness. On ART: immune depletion, anemia, osteoporosis, enterocolitis, autoimmune thyroiditis. Intestinal infection not tested. In the allergy section, rye, wheat, barley, rice are tested.

Avoid grains and rice.

Take decoctions of oats, flax seeds.

BRT along the meridians: lungs, bladder, allergy.

EPT - E-programs: 1; 124; 192; eleven.

Complex preparation: organopreparation ( ileum D6, small intestine mucosa D6, jejunum D6) + homeopathy ( Colocynthis D6, Colehicum D6).

homeopathic remedy– Nux vomica comp.

After 2 weeks, the patient's health improved significantly, but the immune system remained in a state of exhaustion. The above treatment of celiac disease was supplemented: TF (classic transfer factor) 4 capsules a day alternate with TF Advensd 3 capsules a day for 20 days. Then, every 20 days, reduce 1 capsule (both drugs).

A month later, the patient's condition improved significantly. Analysis for antibodies to gliadin 40 IU / ml (weakly positive).

After 4 months: the state of health of the patient with a diagnosis of celiac disease is good. Analysis for antibodies to gliadin 30 IU / ml (number of the risk zone).

The patient continues to take complex homeopathy and has eliminated cereals and rice from her diet. Feeling good, no complaints.

Clinical example of treatment No. 2 for celiac disease

The eldest daughter of the patient, 40 years old. Allergy complaints allergic dermatitis, abdominal pain, stool - frequent diarrhea. Allergy to cereals and rice was tested on ART. Analysis for antibodies to gliadin 40 IU / ml (weakly positive).

The same treatment for celiac disease was given as for the mother. Feeling good. The observation period is 4 months. Analysis for antibodies to gliadin 30 IU/ml (risk area).

Clinical example of the treatment of enteropathy No. 3

Youngest daughter, 34 years old. Complaints of periodic pain in the abdomen, sometimes diarrhea. History of delayed menstruation, anemia, stunted growth. Allergies to cereals and rice were also tested on ART. Analysis for antibodies to gliadin 30 IU/ml (risk area). It is recommended: to exclude cereals and rice from the diet, Nux vomica comp was tested in a potency of 500: 3 peas 2 times a week.

Risk groups for gluten celiac disease

The following risk groups are distinguished, which should be carried out by immunological screening diagnostics:

patients with clinical symptoms of celiac disease, giving reason to suspect a malabsorption in the intestine: undersized children lagging behind in physical development; people suffering from unexplained allergies, anemia, hypocalcemia, osteoporosis, delayed puberty; patients with amenorrhea and infertility, the cause of which could not be clarified;

the closest relatives of patients diagnosed with celiac disease (parents, children, grandchildren);

patients suffering from diseases associated with celiac disease.

The factors provoking an exacerbation of the disease or the manifestation of the first clinical symptoms of celiac enteropathy are most often pregnancy and childbirth, neuropsychic trauma, less often - intercurrent (comorbid) diseases, acute intestinal infections.

Groups of people with celiac disease

People with a perceived potential gap can be divided into two groups:

the first group - people with a normal mucous membrane and normal total MEL, but a high proportion of gamma / delta lymphocytes among them;

the second group - the closest relatives of patients with celiac disease, in which the mucous membrane of the small intestine is normal. However, detailed immunological and ultrastructural analysis reveals that most people in this group have an increased number of MELs, especially gamma/delta cells, an increased number of mitoses in crypt cells, and an increased expression of HLA class II.