Celiac disease ranks second in frequency of occurrence, following only hypolactasia (milk intolerance). It is estimated that up to 1 in 100 people may be suffering from celiac disease. In Poland, only 3-5% of all cases are diagnosed. Unfortunately, the remaining afflicted are not aware of their disease, which, if not cured, leads to serious medical problems.
Let us then explain what the celiac disease really is.
Celiac disease is a life-long immune-based disease with a genetic origin. It is characterized by intolerance of gluten – a spare protein found in such grains as: wheat, rye, barley, or oats. The toxic effect of gluten leads to atrophy of intestinal villi, which are responsible for increasing the intestine’s surface and for absorption of nutrients. Therefore, their atrophy causes nutrients to be absorbed in minimal amounts, which leads to various clinical symptoms.
The only treatment for celiac disease is life-long adherence to a strict gluten-free diet. In those sick, who have not been diagnosed, or who do not follow the diet, there is an increased risk of digestive system cancers, including the most common small intestine lymphoma (40x more common than in general population). However, following a strict diet for five years reduces the risk to the level of that of general populace.
Until recently, celiac disease has been believed to be a rare affliction, which occurs mostly in small children. Unfortunately, this view still lingers in many circles, despite our modern knowledge that celiac disease can occur at any age. Just as the age differs, so does the disease’s clinical image.
The intensity of celiac disease symptoms is varied: from mild weakness, through oral cavity inflammation, bone pains, to chronic diarrhea and severe weight loss.
There are three commonly distinguished types of celiac disease (considering the kind and severity of symptoms):
This form is relatively easy to notice, due to peculiar symptoms (however, statistically it is much less common than asymptomatic form). Unfortunately, even this form is often unrecognized, because symptoms are believed to be symptoms of another disease, for example irritable bowel syndrome or food allergy. The symptoms are: stomach aches and bloating, diarrheas (watery or with excess fat), weight loss, childhood development disorders (especially of growth, so short stature), malnutrition symptoms (being a result of improper absorption), as well as changes in attitude, and often even depression.
ASYMPTOMATIC FORM (subclinical, silent)
This form occurs 7 times more often than the symptomatic one, however due to nonspecific symptoms it is often difficult to diagnose. The only visible changes are in the wall of the small intestine. Usually does not display symptoms typical to symptomatic form. Sometimes the only symptom is a stomach ache. Among common symptoms are: canker sores, unexplained anemia due to iron deficiency, enamel hypoplasia, heightened cholesterol levels, persistent headaches, neurological dysfunctions (peripheral neuropathy, ataxia), joint and bone pains, early osteoporosis, skin problems (hinting at Duhring’s disease), as well as fertility problems and recurrent miscarriage.
LATENT FORM (hidden)
We talk about this form, when there is a presence of endomysial antibodies (IgA EmA), yet the image of intestine is correct. In this case we can expect atrophy of intestinal villi in the future.
Aggravation of symptoms and reveal of celiac disease may be influenced by infection, surgery, or pregnancy.
It has been determined that some ailments, though appearing not to be associated with celiac disease, are actually comorbid with it. Their appearance may be related to an unrecognized asymptomatic form of celiac disease, and they may be its only symptom. Among these are: anemia due to iron deficiency, hyposplenism, vitamin K deficiency (thrombocytosis), vein inflammation, early osteoporosis, rheumatoid arthritis, short stature, autism, epilepsy, depression, neurosis, dementia, various myopathies, balance and speech disorders, nystagmus, liver fibrosis, fatty liver, glomerular nephritis, type I diabetes, fertility dysfunctions, tendency towards miscarriage, thymus and pancreas diseases, Addison’s disease, asthma, sarcoidosis, high cholesterol, canker sores, or enamel hypoplasia.
Due to the variety of manifestations, celiac disease is not easy to recognize. However, once the diagnosis is given, we may feel lost in our new gluten-free world. We need to remember that this diet is the only treatment, and that we need to follow it for the rest of our lives, which may seem somewhat frightening. Someone just diagnosed with celiac disease is lost in their new circumstances, so that often they do not even know what questions they should ask. This is why we give our patients a helping hand: we try to explain, in the most accessible way, what celiac disease is, which products they should and shouldn’t consume, how long these dietary restrictions will last and what are the benefits of a well-conducted gluten-free diet, where to find food products and how to tell which of them will not hurt us. We understand, that these questions will keep appearing with time.