Coeliac disease (CD) is a permanent intolerance to gluten in wheat, barley, rye and possibly oats that occurs in genetically predisposed individuals, characterized by an inflammatory reaction, immune based in the mucosa of the small intestine that hinders absorption of macro and micronutrients.
The estimated Europeans and their descendants prevalence of 1 %, being more common in women with a 2:1 ratio.
A significant percentage of patients (75 %) are undiagnosed due, mostly, to the CD, for years, has been associated exclusively with its classic clinical presentation. However, the recognition of other atypical forms of manifestation, oligo-and asymptomatic, combined with the highest and best use of the additional evidence available, has allowed revealing the existence of different types of CD:
- Symptomatic: Symptoms are varied but all patients displayed serology, histology and genetic test compatible with CD.
- Subclinical: In this case there will be no symptoms or signs, although they will be positive other diagnostic tests.
- Latent: Are patients at any given time, consuming gluten, have no symptoms and the intestinal mucosa is normal. There are two variants:
- Type A: CD were diagnosed in childhood and recovered completely after starting gluten-free diet, staying in subclinical state with normal diet.
- Type B: In this case, due to a previous study, it was found that the intestinal mucosa was normal, but later develops the disease.
- Potential: These people have never provided a biopsy CD supports but, similarly to the above groups, have a genetic predisposition for positivity determined HLA-DQ2/DQ8. Although serology may be negative, have an increased number of intraepithelial lymphocytes. The average probability of developing active CD is 13% and 50% latent CD.
COELIAC DISEASE SYMPTOMS
The most common symptoms are: weight loss, loss of appetite, fatigue, nausea, vomiting, diarrhea, abdominal distension, muscle wasting, growth retardation, mood changes (irritability, apathy, withdrawal, and sadness), abdominal pain, bloating, and deficiency anemia resistant to iron treatment. However, both in children and in adults, symptoms may be atypical or absent, making diagnosis difficult.
DIAGNOSIS OF COELIAC DISEASE
By careful clinical examination and blood test, including serological markers of celiac disease (antigliadin, endomysial and tissue transglutaminas) the suspected diagnosis of the disease is established. The recent awareness of different clinical forms of coeliac disease (atypical, classic, silent, latent and potential) has come to show that you can not always establish a functional or clinical diagnosis of coeliac disease. Therefore, for the accurate diagnosis of coeliac disease is essential to perform an intestinal biopsy. This biopsy is the removal of a sample of tissue from the upper small intestine to see whether or not damaged. To perform this test is not necessary has been removed gluten from the diet.
TREATMENT OF COELIAC DISEASE
Treatment consists in following a strict gluten free diet for life. This leads to clinical and functional standardization and repair villous injury. The coeliac should base your diet on natural foods: vegetables, meat, fish, eggs, fruits, vegetables and cereals gluten free rice and corn. Should be avoided as far as possible, processed and/or packaged foods, since these are more difficult to ensure the absence of gluten.
Ingestion of small amounts of gluten, on an ongoing basis, can cause significant and undesirable conditions.
ASSOCIATED DISEASES
Usually precede the CD, but can also occur simultaneously and even after it. Patients who suffer are considered risk groups and their association occurs with a frequency higher than expected:
- Dermatitis herpetiformis.
- Diabetes mellitus type I.
- Selective IgA deficiency.
- Down Syndrome.
- Liver disease.
- Thyroid Disease.
- Lactose intolerance.
COMPLICATIONS
Although normally are developmental disorders of the disease in the absence of early diagnosis, or patients with poor adherence to gluten-free diet, it is sometimes presented in the form of people over 50 years:
Non-Hodgkin lymphoma. The risk of developing this complication is 2 times higher than the general population, equaling to it after carrying out a gluten-free diet for 5 years.
Carcinomas. They are squamous cell esophageal and oropharyngeal level, or adenocarcinoma in the small intestine or rectum.