celiac Disease

Celiac disease: short overview

• description: Overreaction of the immune system to the gluten gluten and an endogenous enzyme that cleaves it; Inflammation of the small intestinal mucosa; Deficiency symptoms due to inferior nutrient uptake.
• symptoms: occur after eating gluten-rich foods: abdominal pain, bloating, diarrhea, often atypical discomfort.
• treatment: gluten-free diet, no wheat, barley, rye, greens, etc., compensation for deficiencies, so far no causal therapy.
• diagnosis: Celiac disease test: detection of antibodies in the blood, biopsy of the small intestinal mucosa, self-tests provide insufficient results.
• Progonose: Left untreated, complications such as lactose intolerance or cancers in the gastrointestinal tract may develop.

What is celiac disease?

In celiac disease, the small intestine becomes inflamed. Guilt is the immune system. It classifies the actually harmless gluten gluten as dangerous and responds as soon as patients absorb gluten from food. This is found in many cereals such as wheat, rye, barley, spelled or greens. And also a body-own substance calls the immune system of celiac disease patients on the plan: the enzyme tissue transglutaminase. It splits the gluten in healthy people.

Because gluten and tissue transglutaminase are located on the intestinal mucosa, it is inflamed by attacks of the immune system. Over time, the mucous membrane is so severely damaged by the chronic inflammation that the food can no longer be absorbed normally into the blood via the intestine. Normally, the intestinal mucosa is wrinkled, forming so-called villi. This structure enlarges the surface of the intestine. This has the advantage that the food components can pass more quickly from the intestine into the blood. In celiac disease, the autoantibodies destroy these protuberances. The result: It can lead to severe deficiency symptoms, because less surface is available for nutrient absorption.

Allergy or autoimmune disease?

Whether celiac disease is an allergy or an autoimmune disease, experts also argue. The fact is: celiac disease has both elements of an allergy and an autoimmune disease.

An allergy is generally an excessive reaction of the immune system to actually harmless substances. This is the case with celiac disease, as the immune system reacts to the actually harmless gluten with an excessive immune response.

On the other hand, the immune system in celiac disease but also forms antibodies against the body’s own enzyme tissue transglutaminase. Since in celiac disease the immune system also attacks the body’s own structures, the definition of an autoimmune disease is thus fulfilled for the gluten allergy. According to current knowledge, celiac disease is most likely a hybrid of allergy and autoimmune disease. However, the term gluten allergy has not prevailed in science and should therefore rather be avoided.

Celiac Disease: Symptoms

If people with celiac disease eat gluten-containing foods, they will experience typical symptoms. These include primarily abdominal pain, flatulence and greasy diarrhea. In addition to these short-term symptoms, it also comes to long-term impairments: In celiac disease, the mucous membrane of the intestine is damaged by the inflammation, so that all food components are less likely to be absorbed into the body. As a result, severe deficiencies may develop, such as iron deficiency. Through this, the body can hold water in the vessels worse. Instead, it gets lodged in the tissue – it forms edema. Celiac patients also lose weight often due to gastrointestinal symptoms.

Atypical symptoms

In some patients, gluten intolerance is associated with atypical symptoms, that is, complaints that are not directly related to bowel function, such as skin problems. Celiac disease is often recognized late. The most common atypical signs include:

• Liver disease with partly slightly elevated liver values
• Dermatitis with itchy reddish raised blisters
• Anemia, tongue burns, mouth rots (due to iron deficiency)
• Osteoporosis, muscle weakness, muscle cramps, bone pain (due to calcium deficiency)
• Bleeding, for example in the skin (due to vitamin K-Magel)
• Night blindness (due to a vitamin A deficiency)
• Thyroid dysfunction
• Inflammation of the renal corpuscles
• joint pain
• mood swings
• depression
• Epileptic seizures
• Motor coordination disorder
• nerve disorders

Celiac symptoms in children

Even in a toddler, gluten intolerance can cause symptoms of indigestion. These can be through a distended abdomen, voluminous, foul-smelling diarrhea or in one refusal to eat express. Some children fall to the pediatrician for checkups because they no longer grow properly or their puberty is delayed. Also in children is iron deficiency a typical symptom of gluten intolerance. Signs of celiac disease can also Essence or behavior changes be the child. The children are then noticeably whiny, sullen or apathetic. Celiac symptoms often occur in children towards the end of their first year of life, about three to six months after the first gluten-containing cereal meal.

Celiac disease without symptoms or with little discomfort

In some people, the typical antibodies for celiac disease in the blood can be detected and the small intestinal mucous membrane is characteristically changed. Nevertheless, the patients have no complaints or only minor, atypical symptoms such as fatigue or tiredness. A gluten-free diet is often unnecessary. In most cases, celiac disease is detected as part of a screeing examination, which is performed because close relatives have celiac disease.

Sometimes celiac antibodies can already be detected before the small intestinal mucus has changed. This may develop celiac disease with symptoms, but it does not have to happen.

Celiac disease: treatment

If a person suffers from celiac disease, the disease accompanies him throughout his life. So far, there is no healing therapy. Affected people have to eat permanently gluten-free. If this is done consistently, the symptoms are almost always completely back. As part of the celiac treatment, any existing deficiencies are also compensated until the attacked intestine has normalized.

Celiac Treatment: Nutrition

Freshly diagnosed celiac disease patients initially feel extremely restricted in their diet. In fact, from now on, they will have to cut a variety of foods off the menu. However, the more intensively those concerned are informed about the gluten-free diet, the more opportunities they will find to eat a gluten-free and yet varied diet.

The following information will help you to find out which cereals and foods you avoid when gluten intolerance and which you can consume without hesitation:

Strictly avoid: gluten-containing cereals

The following cereals and products containing them should completely and permanently avoid gluten intolerance:

• wheat
• rye
• barley
• Spelt
• Grünkern
• triticale
• einkorn
• Emmer Kamut
• occasionally oats (does not cause complaints for all concerned)

Gluten-containing foods

Gluten is also present in many cereal-based products. In principle, manufacturers have been required since 2005 to label gluten-containing foods according to the allergen labeling requirement. Gluten-containing ingredients such as wheat must appear on the list of ingredients (exceptions: syrup, spirits). However, the term “gluten” itself need not be mentioned. For people with celiac disease, it is therefore necessary to know which ingredients contain gluten. A food is considered gluten-free if it contains a maximum of 20 ppm (2 mg per 100g) of gluten. There is also a special symbol labeled with gluten-free foods: a crossed out ear of wheat.

The following foods are almost always gluten. You should also avoid this as a celiac disease patient.

• Bread and other baked goods
• noodles
• Pizza
• Muesli and other breakfast cereals
• Cookies
• breaded meat
• mum
• beer
• Soy sauce (there is also gluten-free soy sauce)

Gluten-free cereals

Fortunately, there are also some cereals that contain no gluten and thus are safe for people with gluten intolerance. The gluten-free cereals include:

• rice
• Corn
• millet
• buckwheat
• Amaranth
• quinoa
• wild rice
• Teff (dwarf millet)

Gluten-free foods

The following foods are naturally free from gluten. They can therefore be eaten without hesitation (unless they contain gluten-containing additives):

• All fruits and vegetables
• potatoes
• Meat, poultry, fish, seafood
• Legumes such as soy
• Eggs, milk, milk products, butter, margarine
• Jams, honey
• Sugar, salt, herbs
• Nuts and oils
• Water and juices
• Wine and sparkling wine
• coffee and tea

Celiac treatment: therapy of deficiency symptoms

In a celiac disease inflamed due to the attacks of the immune system of the intestine. This can interfere with the normal absorption of nutrients into the blood. In particular, vital vitamins and trace elements are affected and must be supplied by celiac disease if deficient. Vitamins often lack vitamin A, vitamin B6 and B12, folic acid and vitamin K. But the trace elements iron, magnesium and calcium are also inadequately absorbed in celiac disease.

The various deficiencies can sometimes have serious consequences. For example, too little iron, folic acid or vitamin B12 triggers anemia (anemia). The lack of vitamin K can lead to heavy bleeding. A typical consequence of calcium deficiency is muscle cramps.

If deficiency symptoms appear, the missing vitamins and trace elements must be artificially added. In lighter cases, this is possible in the form of tablets or capsules. Sometimes, however, an infusion via the vein or at least an injection into the muscle is necessary because the inflamed intestine could absorb the missing substances only insufficient.

Celiac disease treatment in the baby

If a pregnant woman suffers from celiac disease or there are relatives with this condition in her family, she should be her child to breastfeed for as long as possible, Breast milk has been shown to have a protective effect against celiac disease. Studies from the US and Sweden also suggest that low levels of gluten-containing foods in middle-aged infants may also be preventive. This had the biggest effect in the fifth to seventh month of life. This means that children who were fed gluten-containing foods at this age later suffered less celiac disease. However, children who come into contact with gluten earlier seem to be at increased risk for celiac disease.

In case of suspected celiac disease in infancy and childhood should be checked immediately, if a gluten intolerance is responsible for the complaints. Otherwise, undetected and therefore untreated celiac disease may be at risk of serious developmental disorders due to the lack of vitamins, trace elements and nutrients.

Non-treatable celiac disease

The so-called refractory celiac disease is a very rare form that occurs in about 1.5 percent of celiac disease patients. In refractory celiac disease, the typical signs of gluten intolerance can be found in the blood and in a small intestine sample. However, the person affected can not positively influence the disease with a strict gluten-free diet. A refractory celiac disease is when the symptoms do not subside during a twelve-month gluten-free diet or typical or atypical celiac symptoms recur after improvement. In this case, the symptoms can only be relieved with medication. At causal therapeutic approaches is being researched.

Celiac Disease: Causes and Risk Factors

The mechanisms involved in celiac disease in the body are already relatively well understood. Nevertheless, it has not yet been possible to clarify why celiac disease ultimately develops. Among other things, genetic factors contribute to this. Since not all people with a corresponding predisposition actually get celiac disease, there must be other influencing factors. It is believed that diet and other environmental factors also play a role.

Hereditary factors

In celiac disease, hereditary factors are very likely to play a significant role. About 90 percent of those affected possess a certain surface protein on the immune cells. This protein binds fragments of the gluten and is involved in the inflammatory immune response. Since it is inherited, have family members of sufferers about ten to 15 times higher risk of developing celiac disease. Other autoimmune diseases such as a form of diabetes mellitus (type 1 diabetes mellitus) or autoimmune thyroid inflammation have been implicated in this surface protein. However, about 30 to 40 percent of healthy people also possess this surface protein. Therefore, environmental factors also seem to have an important influence on the development of the disease.

Nutrition and environment

People who have come into contact with gluten-rich foods as newborns are more likely to develop celiac disease. Baby food should consist of breast milk or gluten-free food, especially if the child has close relatives with gluten intolerance. From the fifth month of life, however, small amounts of gluten can be preventative again. Infections with intestinal viruses or a change in the bacterial intestinal flora are also discussed as potential risk factors. In addition, psychosocial factors should contribute to the development of celiac disease.

Related to other diseases

Celiac disease is more common with other diseases. People with Turner syndrome, Down syndrome, IgA deficiency, type 1 diabetes and other autoimmune diseases such as autoimmune thyroid disease (thyroiditis) or liver inflammation (autoimmune hepatitis) are more likely to develop gluten intolerance. Why celiac disease also frequently occurs in these diseases, but is still unclear.

Celiac disease: examinations and diagnosis

The right contact for suspected gluten intolerance is a specialist in internal medicine, which specializes in diseases of the digestive tract (Gastroenterology).

Celiac disease: history and physical examination

First, the doctor inquired about your current complaints and any previous medical history (medical history). For example, if he suspects celiac disease or has a positive celiac self-test, he might ask you the following questions:

• Do you often suffer from diarrhea or abdominal pain lately?
• Have you lost weight in the past few weeks and months?
• In children and adolescents: are growth disorders present? Is puberty slowing down?
• Have you noticed abnormalities of the skin?
• Is there a gluten intolerance in a family member?
• Have you ever had a celiac disease test or have you performed a self-test?

On the anamnesis follows the physical examination, The doctor is looking for celiac-specific abnormalities of the skin and tongue. He listens with the stethoscope to the abdominal cavity to check the bowel sounds. He also taps and palpates the patient, where he can detect increased air in the stomach, fluid but also intestinal thickening. Since the intestine can only be assessed from the outside to a limited extent, further investigations are usually necessary for a diagnosis of celiac disease.

Celiac Test

A celiac disease test detects antibodies in the blood serum that are typical of gluten intolerance. In severe celiac disease, a test on the breathing air is possible. There is also a self-test to detect a gluten intolerance. However, this does not work very reliable. You should not rely on the result of the self-test, but always consult a doctor.

When to perform the celiac disease test and how exactly it runs, read in the article celiac disease test.

In addition to the celiac disease test, a tissue sample can be taken from the small intestine. If this has the typical celiac disease changes, there is a gluten intolerance. The tissue sample can be omitted if typical symptoms of celiac disease occur, very high antibody levels are present and there is a typical genetic predisposition to celiac disease.

If the diagnosis is uncertain despite the tests that have been carried out, you should first carry out a gluten-free diet of eight weeks. Following this, after a targeted gluten exposure, both the tissue sample and the celiac disease test in the blood can be repeated.

A celiac diagnosis is not always easy, because not all patients suffer from the typical symptoms. Up to 90 percent of those affected complain about atypical signs of disease, which are often misinterpreted for many years. It takes an average of four years to make the diagnosis.

Celiac Disease: Disease course and prognosis

Celiac disease is a disease that accompanies those affected throughout their lives. Under a gluten-free diet, however, symptoms usually disappear completely. However, a gluten-free diet initially poses major problems for many people, as it means a massive cut in their dietary habits. However, if the person concerned deals extensively with the possibilities of gluten-free nutrition, a varied diet is possible.

Celiac patients with long-term disease are at increased risk for certain cancers of the gastrointestinal tract (intestinal T-cell lymphoma, adenocarcinoma). In addition, by the inflammation in the intestine serious deficiencies of vitamins, trace elements and other nutrients may arise and also other disorders of digestion, such as lactose intolerance occur. Intestinal inflammation leads to a deficiency of the lactose-splitting enzyme lactase, which normally functions in the intestinal mucosa of the small intestine. As a result, the lactose can no longer be digested, and lactose intolerance often occurs at least temporarily. All of these illnesses are mostly irrelevant to people who know about their condition and can protect themselves with a gluten-free diet.

However, there are many people who have not yet been diagnosed with celiac disease. Thanks to new examination options, the disease can now be easily diagnosed. Especially people with typical complaints, associated comorbidities and relatives with celiac disease should be tested.

Celiac disease: frequency

Celiac disease is a common disease in Germany. According to the German Society for Celiac Disease suffers in this country every 200th person under a gluten intolerance. However, the majority of those affected do not have a full picture of the disease. That said, many people have proven celiac disease, but the symptoms are low or moderate.

Total are Women affected more often as men. Celiac disease in children occurs frequently between the first and eighth year of life and in adults between the ages of 20 and 50 years. In principle, however, the disease can develop at any age.

According to the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS), the number of celiac disease cases in recent years continues to increase. This is probably due to the fact that the disease is now known and can also be better diagnosed. Other reasons include environmental factors such as gastrointestinal infections, altered dietary habits and psychosocial factors. However, there is no clear explanation for the increase in cases of illness.

Additional information

guidelines:

• S-3 guideline of the German Society of Gastroenterology, Digestive and Metabolic Diseases: celiac disease, wheat allergy and wheat sensitivity

Support Groups:

• German Celiac Society: In addition to medical information you will find numerous gluten-free recipes and cooking ideas here.