Gluten enteropathy (celiac disease) - diagnosis. Celiac disease, what is it? Symptoms, causes and treatment. Additional research methods

celiac disease- a disease caused by the absence or insufficiency of intestinal enzymes that are involved in the digestion (breakdown) of gluten contained in some cereal crops. Such fermentopathy can be congenital or acquired. The manifestation of celiac disease is the most diverse and depends on many reasons.

In 1888, a London physician, Samuel Guy, published for the first time his observations of an unusual disease that he discovered in a hospital in some small patients. The disease was characterized the following symptoms: liquid stool, weight loss, anemia, stunting, etc. The Englishman "christened" this disease celiac disease(from the Greek word koiliakos- intestinal), since the pathology affected the intestines.

It was only later that the "capricious" disease acquired a bunch of names, as if imitating the many-named Anna-Louise-Mary. Often, when diagnosing a disease, Aesculapius use a variety of terms: celiac disease, celiac disease, Gi-Herter-Heibner disease, European sprue, gluten enteropathy, etc.

Celiac disease and "bad" grains

Cereals such as wheat, barley, oats and rye are known to contain gluten (gluten). In the grains of these crops, it is about 10%. In the intestines healthy person Under the action of specific enzymes, gluten is digested (broken down) into easily digestible components. But in some people, these intestinal enzymes are produced little, and sometimes they are completely absent. In these cases, the process of splitting gluten does not go to the end. The resulting intermediate substances are alien to humans. An example of incomplete breakdown of gluten is gliadin. As a result toxic action of this substance on the intestinal wall, inflammation develops in it. Over time, atrophic processes develop, the microbial landscape changes. In a person suffering from celiac disease, polyhypovitaminosis is observed, the balance of electrolytes is disturbed. In the absence of adequate treatment, it inevitably develops chronic enteritis with malabsorption syndrome. And this is a very serious problem.

Bread is the head of everything

In Russia, bread is important product nutrition. Let us recall at least the proverbs: “bread is the head of everything”, “you won’t be full without bread”.

Recently, a disease called celiac disease, or celiac disease, has become widespread. It represents the reaction of the human body to the use of gluten. It is an immune-dependent mucosal disease small intestine. People with congenital sensitivity to gluten suffer from pathology. The latter is found in cereals such as rye, wheat, barley. Therefore, it is recommended to exclude them from the diet.

The use of gluten provokes an inadequate response of a fragment of the immune system, which is located in the small intestine. Gradually, this forms an inflammatory process that damages the shell of the organ. After a while, the body begins to lack nutrients that he needs for normal functioning. For this reason, the bones, liver, pancreas, brain and other organs suffer. Damage small intestine leads to bloating, weight loss and diarrhea.

What is gluten enteropathy

Gluten enteropathy (another name is "celiac disease") - chronic pathology disrupting the functioning of the small intestine. Usually, its symptoms manifest themselves clearly in childhood. The older the person, the less noticeable the signs of this disease. Pathology reveals itself well if the sick person eats food containing a lot of gluten.

Such people should completely exclude wheat, rye, oats, barley from the diet, as they are dangerous to health and life. Six months after the patient stops eating these cereals, the full functioning of the small intestine will be restored.

Thanks to modern diagnostic methods there is an opportunity to better study this pathology. Previously, doctors took some of its forms for manifestations of other ailments of the gastrointestinal tract. Once a person is definitively diagnosed with celiac disease, they will have to follow a strict diet for the rest of their lives. Celiac enteropathy is characterized by very unpleasant symptoms: diarrhea, excessive gas emission, severe weight loss.

This disease is rare. Women are more likely to suffer from it, in men the pathology is diagnosed twice as rarely. It is difficult for patients with such a diagnosis to conceive a baby, and pregnancy proceeds with complications. Exists high probability that the child will be born with a latent form of celiac disease.

Forms of the disease

There are five celiac various forms classical flow:

Typical - begins to develop in childhood. Occurs in 38% of patients. It is characterized by steatorrhea, diarrhea, metabolic disorders, anemia. Gastrointestinal symptoms predominate - diarrhea, weight loss, mucous feces, bloating, the body does not process dairy products well.
Atypical - characterized by extraintestinal manifestations in the form of hemorrhagic syndrome, polyarthralgia, disruption of the endocrine and other systems. It occurs in 35% of patients. Symptoms include a decrease in hemoglobin, resulting in weakness, pale skin, lethargy, fatigue, decreased activity. There are also pains in the bones, and an increased tendency to bruise all over the body.
Latent - usually begins to appear in adulthood. Runs the same as typical shape. Occurs in 14% of cases. Symptoms are usually absent. Revealed positive tests for celiac disease.
Refractory (torpid) - runs very hard positive effect from therapy is minimal, and sometimes absent altogether. Cyclosporine and corticosteroids help. This form occurs in 13% of patients. Characteristic manifestations- mucous diarrhea, bloating and weight loss, lack of effect from diets, the body does not tolerate dairy products.
Hidden (asymptomatic) - characterized increased amount interepithelial lymphocytes (IEL). Of the symptoms, diarrhea and bloating are very rarely observed.

Gluten - what is it and why is it dangerous

Gluten is a complex protein. Its task is to collect and glue other proteins into one group. Found in wheat, rye, barley, oats. AT pure form it has no taste, the gluten itself is gray in color. It functions as a concentrate, giving products elasticity. Therefore, its artificial form (modified food starch) are sometimes added to them. For example, in semi-finished meat products, dairy products, yogurts, various sauces (soy, mayonnaise, ketchup, etc.). They acquire a delicate taste due to gluten.

Today, celiac disease affects approximately 1% of the world's population. The immune system of patients perceives gluten as a dangerous element and tries to fight it. A gluten diet cannot be used here, because the danger of pathology lies in pinpoint strikes towards this protein, damage to gastric tissues, digestive tract, brain.

Causes and manifestations of celiac disease

Sometimes this disease is confused with gluten allergy. However, the symptoms of pathologies are different, as is the development process. Celiac disease is a multifactorial disease that damages the villi of the small intestine. Starts the mechanism of the disease the use of protein. It causes the immune system to attack the gut, which contains gluten.

Pathology is expressed both by impaired absorption and atrophic changes intestinal mucosa. The disease affects representatives of any race, different ages, often it appears already in childhood, and may also occur in people of retirement age.

It proceeds in the following stages:

zero (preinfiltrative) - there are no changes in the small intestine;
the first stage (infiltrative) - a lot of intraepithelial lymphocytes appeared;
the second stage (hyperplastic) - intestinal crypts deepen, the villi retain their height;
the third stage (destructive) - reversible atrophy of the villi, first partial, then total;
the fourth stage (atrophic) is an already irreversible change in the intestinal epithelium, oncology may develop.

The defeat of the small intestine in this pathology is carried out under the influence of gluten. As already mentioned above, this protein is found in cereals. It consists of glutenin, globulin, prolamine, albumin. The intestines attack prolamine, which is found in cereals in different amount. Less of it in corn, barley, oats.

The main factor in the development of celiac disease is genetic predisposition. In such people, when the protein comes into contact with the intestine, antibodies begin to be produced. Further, inflammation develops, which gradually leads to atrophy of the small intestinal mucosa.

Still exact reason Why some patients develop celiac disease is unknown.

But doctors have traced a certain connection with some pathological conditions:

allergy - sensitization to a peptide, gliadin, which can lead to the formation of antigens;
heredity (genetic) - characterized by a violation of the breakdown of gluten;
adenovirus - provides excessive sensitivity of the intestine to the protein.

Sometimes pathologies such as type 1 diabetes, all types, lymphocytic, become the cause of celiac enteropathy.

Symptoms of celiac disease in adults and children

Pathology is associated with damage to the intestinal mucosa and forms atrophy .

Adults report the following symptoms:

anemia and weight loss without a specific cause;
diarrhea, abdominal pain;
irritability, anxiety state, sharp drops sentiments;
infertility, miscarriages;
chronic fatigue, excessive sweating, lack of air, weakness, headaches;
mental deviations - talking with oneself, atypical behavior for a mentally healthy person, depression, epilepsy;
caries;
joint and muscle pain in severe cases atropopathy, osteoporosis may develop, fractures occur;
lack of appetite, pain after eating, nausea and vomiting after eating dairy products;
hemorrhages, including intestinal, the risk of developing lymphoma;
thirst, a quarter of patients develop diabetes of the first degree.

In children, the pathology is expressed more vivid symptoms. In most cases, there are signs of damage to the gastrointestinal tract.

Symptoms of celiac disease in children under 2 years of age:

offensive diarrhea (in large quantities) yellow and gray;
vomiting with nausea;
the baby does not gain weight, sometimes anorexia appears;
tremor of hands and feet, psychomotor agitation;
flatulence, bloating.

Symptoms in older children:

anemia;
abnormal stool - diarrhea alternates with constipation;
light weight;
lack of appetite, alternating with a feeling of constant hunger;
autism;
alopecia;
allergies (in any form);
osteoporosis.

And now a more detailed clinical picture. The main signs of pathology are steatorrhea, diarrhea, sudden weight loss, malabsorption syndrome. Enteropathy in babies begins to manifest itself from about 10 months of age. There is diarrhea with large quantity fat, body weight decreases, the child lags behind peers in growth.

In adults, the appearance of symptoms of this pathology is provoked by surgical operations, infection in the body, and pregnancy. Patients notice a tendency to drowsiness, decreased performance, flatulence, unstable stools, constant rumbling in the abdomen, and belching.

The stool is liquid, frothy, quite frequent, with the remnants of food that has not been digested - from 5 times a day or more. If diarrhea continues for a long time, dehydration occurs: the skin and mucous membranes become dry.

Elderly patients have pain in muscles and bones. Malabsorption syndrome develops, which contributes to the appearance of homeostasis disorders. In the fair sex, in most cases, symptoms of celiac disease begin to appear at the age of 30-40, in men - after 40-50.

Complications

If celiac disease is left untreated, there is a high risk of complications.

The most common of them:

neuropathy;
malignancy;
chronic colitis.

In patients with enteropathy, cancer and lymphoma develop much more often. The patient needs to monitor his condition and laboratory parameters. If they unreasonably worsen, and an anti-gluten diet does not help, then this may indicate that a malignant process has begun to develop in the body.

Chronic colitis is manifested by the formation of ulcers in the intestines. They often bleed. And neuropathy expresses itself with numbness, weakness, tingling in the legs. The nerve fibers of the hands are rarely affected. Brain cells are more often affected.

General complications:

Infertility (both female and male).
Depletion of the body. Appears due to malnutrition. Damage to the small intestine contributes to poor absorption of beneficial micronutrients, and their deficiency causes weight loss and anemia in adults. In children, it slows down the development of both physical and mental.
Lactose intolerance. Pathology of the small intestine causes abdominal pain, diarrhea after eating dairy products that contain lactose, including if they do not contain gluten. However, after the course of the diet, the intestines heal, and lactose intolerance sometimes goes away, but this does not always happen and not for everyone. Doctors try not to make predictions about this, because many people continue to have problems with dairy products after the end of treatment for celiac disease.
Oncology. Celiac disease is fought through a diet that is based on the rejection of foods containing gluten. If you do not adhere to it and do not follow other instructions of doctors, then the risk of developing oncology increases significantly.

Insufficient amount of vitamin D in the body, combined with a small amount of sugar, contributes to a decrease in bone density, which becomes brittle. In 30% of those suffering from celiac disease, the spleen is reduced in size, and in 70% arterial hypotension is noted.

Which doctor treats celiac disease

This pathology is dealt with by a gastroenterologist. To choose the right therapy, the doctor must exclude the symptoms of other pathologies, which are similar to the manifestations of celiac disease.

Diagnostics

The symptomatology is diverse, therefore, a large number of studies are required. In most cases, the disease occurs due to a genetic predisposition. You need to find out a history of gluten intolerance. The main method for diagnosing celiac disease is serological.

In order to make a confident diagnosis of celiac disease, the doctor must familiarize himself with the patient's complaints and compare them with the diagnostic data.

The presence of pathology is indicated by:

UAC, OAM ( general analyzes blood and urine) - reveal the presence of anemia;
anamnesis - patient complaints;
biochemistry - analysis for the content of fats, cholesterol, microelements in the body;
appearance - problems with weight, height, skin color, bruising, etc .;
coprology - analysis for the presence of acids in feces;
Ultrasound of the abdominal cavity;
biopsy of the small intestine - the degree of atrophy is detected and assessed;
x-ray - osteoporosis, dyskinesia is detected;
endoscopy - determines the defeat of the villi of the mucous membrane of the small intestine.

Initially, the doctor finds out when the first symptoms appeared and examines the patient. Further analyzes of urine, feces and blood are carried out. And the diagnostics is completed by instrumental methods.

Therapy for celiac disease

Consists of medication and diet.

Medical treatment includes:

anemia therapy - products containing iron, folic acid;
taking multivitamins;
the use of drugs for diarrhea;
restoration of bone density - saturation of the body with calcium;
taking antihistamines and immunocorrectors;
nutrient solutions and corticosteroids (used only in very severe cases).

Further treatment for celiac disease is diet. If from her there will be no desired effect, the gastroenterologist will prescribe hormonal preparations, which will need to be taken for about 2-3 months.

Gluten Free Diet and Sample Menu

In celiac disease, gluten sensitivity is constant and does not decrease. Therefore, with such a diagnosis, a gluten-free diet is recommended. Moreover, it is desirable that it be observed for life.

Almost all cereals, cassava, and legumes are suitable for a gluten-free diet. Starch can only be used from cassava. Flour is made from nuts. Soy, tapioca, Indian rice grass and some other foods are suitable for the diet. Vegetables are used fresh, frozen and canned.

During the diet, you can eat any fruit and make juice from them. Allowed milk, cottage cheese, cheese and natural yoghurts. From meat, only poultry carcasses are used. You can include soybeans, tofu cheese and peanut butter in the menu. Margarine, lard, baking powder, vegetable and butter are taken from fats.

Breakfast can be corn or rice cakes with honey. Additionally, eat cottage cheese and buckwheat porridge. For lunch, cook baked fish, broccoli soup. Add a light snack in the form of salad leaves with olive oil. For dinner, baked or stewed vegetables and buckwheat pancakes are suitable. Drinks containing caffeine are replaced with green tea, juices, or simply a large number of water.

If you constantly adhere to a gluten-free diet, then the disease will begin to recede, and the body will work at full strength. A proper diet helps prevent intestinal inflammation, reduces the risk of complications - tumors, epilepsy, depression, etc. But if the disease is already in an advanced stage, the diet will only help to contain the symptoms. In this case, it is necessary drug treatment suppressing immunity.

Forecast and prevention

At timely detection celiac disease and proper treatment, the prognosis will be favorable. For example, the diet good effect already in 2 weeks. But the intestines are restored at the microscopic level only after 2-3 years. The patient's life expectancy is not threatened, but he will have to adhere to a lifelong diet.

As for prevention, it does not exist as such.

healthy lifestyle;
regular check-ups with a doctor;
balanced diet.

All people diagnosed with enteropathy should be strictly registered with a doctor and regularly examined. Pathology is insidious, and it is simply necessary to monitor its course. Otherwise, there may be irreversible consequences, which can be avoided by devoting more time to your health and not forgetting about your diet.

AT last years such an 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 a delay in growth and development. Irritation in the intestines can cause abdominal pain, especially after eating.

There is no cure for celiac disease, but with a strict diet, its symptoms can be alleviated.

Symptoms

The signs and symptoms of the disease in question are very diverse, as they completely depend on individual features 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 suffering surgical operation, pregnancy, childbirth, 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 a therapeutic diet, when the intestines are completely healed, lactose intolerance can go away by itself, but doctors do not give any guarantees: some patients have problems digesting dairy products even after they have completed their celiac disease treatment.
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 we move through 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 are able to alleviate the most severe signs of 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 packaged prepared foods unless the packages or packages are labeled "gluten free". 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 oatmeal without any trace of wheat leads 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.

Developing in celiac disease, villous atrophy, degenerative changes in 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 give rise to 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. In the clinical picture of the disease, gastroenterological symptoms may be absent or mild. 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 the observance of a gluten-free diet, should suggest the probable development of a 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 a morphological study of the mucosa of the small intestine. With endoscopy and histological examination of the intestinal tissue, signs are determined atrophic lesion mucous membrane with shortening of the villi, lengthening of the intestinal crypts.

Additional Methods research:

- 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 unpleasant symptoms of the disease cease to disturb the person.

Diet guidelines for celiac disease:

Exclusion of gluten-containing products from the diet (bread, pasta and confectionery);
Mechanical and thermal sparing of the digestive tract (dishes are steamed or boiled, eaten pureed or without grinding);
Exclusion of products that enhance fermentation (milk, legumes);
Restriction of products that stimulate the secretion of the pancreas and stomach (rich meat broths, fatty 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 a violation intestinal digestion and suction. Early symptoms Celiac enteropathy manifests itself 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, malabsorption syndrome is characterized by impaired 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. Clinical Syndromes observed 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:

occult gluten enteropathy: there are no symptoms of malabsorption, but the intestinal mucosa with characteristic features hyperregenerative atrophy and (or) an increased number of interepithelial lymphocytes (IEL);

potential (probable) gluten enteropathy.

The second form of predisease is typical for those who have a normal intestinal mucosa, no symptoms of malabsorption, 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 at the primary prevention of osteoporosis, anemia, infertility, type 1 diabetes mellitus, 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. Wherein obvious symptoms 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 histological examination mucous membrane of the small intestine. 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 post-bulb mucosa. duodenum.

Patients suffering from systemic osteoporosis, complicated by bone pain and fractures, iron deficiency anemia of unknown etiology, primary infertility, autoimmune thyroiditis, it is recommended to examine the 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, the treatment of various forms of 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 enzyme and choleretic drugs.

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, corticosteroids are included in complex therapy.

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 prolonged 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, some patients with a diagnosis of celiac disease are restored normal structure mucous membrane of the small intestine. 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 is 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.