What is Celiac Disease? Celiac Disease Symptoms and Treatment

Celiac disease is a disease that occurs as a result of an abnormal response by the body’s immune system to a substance called gluten found in grains such as wheat, barley and rye. Usually, the first symptoms appear with the consumption of gluten-containing foods after 1 year of age. Initially, symptoms such as nausea, vomiting, diarrhea, weakness are observed. In the following periods, different symptoms such as anemia and skin rashes are added. Although it is a chronic disease, it can be treated and the treatment consists of removing gluten-containing foods from the diet.

What is Celiac Disease?

Celiac disease is a common disease whose incidence is increasing day by day. In most countries of the world, one in every 70 to 200 people has celiac disease. The disease, also called gluten-sensitive enteropathy, occurs for reasons related to the body’s immune system. It is triggered by a misdirected immune response to a protein called gluten, which is found in many grains. Some patients also have an immune response to the enzyme that breaks down gluten. Celiac disease causes symptoms as a result of inflammation in the small intestine. The immune system reacts abnormally to gluten and initiates the inflammatory process.

The intestinal mucosa normally contains small finger-like projections called villi that allow nutrient absorption. The villi increase the intestinal absorption surface and facilitate the passage of nutrients into the blood. As a result of the inflammatory process that develops in celiac disease, the body creates antibodies that damage its own tissues. These autoantibodies destroy these protrusions on the inner surface of the small intestine and the villi are flattened. When these are damaged, no matter how much patients eat, it is not possible to get enough nutrients into the body because there is no full absorption.

Experts continue to research whether celiac disease is an allergic or autoimmune disease. According to recent data, the disease is thought to involve both allergic and autoimmune factors. Allergy is an overreaction of the immune system to substances that are actually harmless to the body. This is also the case with celiac disease, because the immune system responds to harmless gluten with an extreme immune response. On the other hand, the immune system also creates antibodies against the body’s own enzyme, tissue transglutaminase.

Causes of celiac disease

The exact causes that can cause gluten intolerance are still not fully known. But possibly a combination of genetic predisposition and environmental factors triggers celiac disease.

According to recent research findings, partially digested gluten molecules reaching the small intestine wall in susceptible individuals cause an extreme reaction in the immune system. Genetic factors are the most important factor in the development of the disease. Frequently, first-degree relatives of celiac patients, such as parents, siblings, or children, also suffer from the condition. A person’s diet, gastrointestinal infections, and gut bacteria may contribute to the development of celiac disease.

Gluten is found in grains such as wheat, rye, oats, barley and is triggered by consuming any food made from them. On the other hand, since rice, corn, soy or potato do not contain gluten, they can be easily consumed by patients.

What are the symptoms?

Celiac patients experience some typical symptoms when they eat gluten-containing foods. The most common of these are abdominal pain, bloating and fatty diarrhea. These short-term symptoms are then followed by chronic complaints. In celiac disease, the intestinal mucosa is damaged by inflammation and the absorption of all food components is impaired. As a result, important health problems such as iron deficiency develop. One of the important long-term symptoms is weight loss.

Gluten-sensitive enteropathy causes symptoms that are not directly related to bowel function, such as skin problems, in some patients. In such cases, where the disease progresses with atypical symptoms, the diagnosis is often delayed. Symptoms of atypical celiac disease include;

• Itchy and red skin rash (Dermatitis herpetiformis)
• Signs of anemia such as burning in the tongue, weakness, pallor (This anemia due to iron deficiency does not respond to iron treatment due to malabsorption.)
• Bone resorption due to calcium deficiency, muscle weakness, bone pain
• Bleeding due to vitamin K deficiency
• Night blindness (due to vitamin A deficiency)
• Depression symptoms
• Hoarseness
• Epileptic seizures
• Dizziness and balance problems
• Imbalance in hormone levels
• Joint problems
• Aphthae in the mouth
• It can be considered as an attention disorder.

Dermatitis herpetiformis is an itchy and blistering skin disease caused by intestinal gluten intolerance. The rash is most commonly seen on the elbows, knees, trunk, scalp, and buttocks. Dermatitis herpetiformis is often associated with celiac disease-like intestinal changes; however, some patients may not have obvious gastrointestinal symptoms. Dermatitis herpetiformis is currently accepted as the skin manifestation of celiac disease.

What are the symptoms in children?

Symptoms of the disease in infants appear when they take their first cereal products after starting solid foods. After a few weeks to months, classical symptoms such as nausea, vomiting and diarrhea related to the digestive system begin to appear. Symptoms of celiac disease in children under 2 years of age;

• vomiting
• Chronic diarrhea
• Swelling in the abdomen
• Growth retardation
• Anorexia
• Muscle wasting

In children older than 2 years;

• Diarrhea
• Constipation
• Weight loss
• Irritability
• Short stature
• Delayed puberty
• Neurological symptoms such as attention deficit / hyperactivity, learning difficulties, headache, lack of muscle coordination and epileptic seizures may be seen.

Celiac disease; After a surgical procedure, pregnancy, birth, viral infection or severe emotional stress, it may show symptoms for the first time or existing symptoms may be triggered.

How is the diagnosis of celiac disease made?

Researchers estimate that only 20 percent of children and adults with celiac disease are diagnosed. For diagnosis, first of all, a detailed history is taken from the patient and a physical examination is performed by the doctor. Your doctor may order different tests to diagnose celiac disease.

Antibodies in the blood are investigated with a serology test. As a result of the test, elevated levels of certain antibody proteins indicate an immune reaction to gluten. Genetic testing for human leukocyte antigens, HLA-DQ2 and HLA-DQ8, can be used to diagnose celiac disease.

If the results of the tests support celiac disease, your doctor will examine your small intestine with the help of a small cannula with a camera at the end, called an endoscope. He or she may also take a small tissue sample (biopsy) during the procedure to analyze the damage to the villi if needed.

These tests need to be done before starting a gluten-free diet to be accurate. Removing gluten from your diet can alter blood test results and results may be normal.

How is celiac disease treated?

The only option in the treatment of celiac disease is the complete elimination of gluten-containing foods from the diet. For this, it is necessary to know the foods containing gluten. All kinds of foods such as wheat, barley, rye and bulgur made from them, semolina, pasta, noodles, cakes, pastries contain gluten.

Your doctor will refer you to a dietitian who can help plan a healthy gluten-free diet. When you eliminate gluten-containing foods from your diet, inflammation in your small intestine usually begins to subside within a few weeks. You may start to feel better in a few days. Complete healing and regrowth of intestinal villi can take from several months to several years. The healing process in the small intestine tends to happen faster in children than in adults.

If you accidentally eat a gluten-containing food, you may experience symptoms such as stomachache, nausea and diarrhea. Some people experience no symptoms after eating gluten; however, this does not mean that gluten does not harm them. Even small amounts of gluten in your diet can be harmful, regardless of signs or symptoms. If a serious nutritional disorder has emerged, your doctor may recommend vitamin and mineral supplements. Supplements of calcium, folic acid, iron, zinc, vitamin B12, vitamin D and vitamin K are generally recommended.