This disease is characterized by intolerance of protein occurring in cereal, i.e. gluten, which damages intestinal villi. Such damage leads to nutrient absorption disorders. Removing gluten from the diet allows the intestinal mucosa to regenerate and symptoms to recede. People suffer from celiac disease in countries where gluten-rich grain, i.e. wheat, rye and barley, are basic food.

The disease can come in various forms:

1.         Classical form – the most common form of the disease; the patient presents full clinical symptoms and mucosal atrophy. Typical symptoms include diarrhoea, abdominal pain, failure to gain weight (in little children), lack of appetite, shortness.

2.         Asymptomatic form – when symptoms are discrete and occur beyond the digestive system, e.g. anaemia, enamel damage, emotional disorders.

3.         Latent form – occurring in people genetically predisposed to celiac disease. Although test results show no atrophy, symptoms of the disease did occur or will occur in the future together with mucosal atrophy of the small intestine. In such cases, test results show serologic markers of celiac disease.

4.         Potential – genetic predisposition to celiac disease.

In Poland, the classical form of celiac disease affects 1 person in 1500 (in Europe: 1 person in 1000), while its asymptomatic form affects 1 person in 130-500. Clinical symptoms of this disease may appear after long-term exposure to gluten. Symptoms appear later if the child is breastfed, however, introducing gluten to a diet early may speed up the process of disease development. At present, celiac disease in usually diagnosed in children at kindergarten or school age and less frequently in children under the age of 2. The disease may be caused by such factors as infection or another disease like diabetes.

Celiac disease can be diagnosed by clinical tests, blood tests – serologic markers of celiac disease and biopsy of the small intestine mucosa.

Serological markers of celiac disease, most commonly used for diagnostic purposes, are as follows:

1.         Endomysial antibody (EmA) – routinely assayed in IgA , for people with IgA deficiency – in IgG.

2.         Tissue transglutaminase antibodies (tTG)

3.         Biopsy of the small intestine and histopathological examination of tissue is NECESSARY for diagnosis.

Introduction of an appropriate diet is impossible without undergoing the above mentioned test.

Tissue samples are taken from the duodenum, usually by endoscopic means. Gluten-free diet should be followed during whole life (as the current state of knowledge suggests). The diet eliminates products contain wheat, rye, barley and oats. Gluten-free products are considered to be naturally gluten-free. These are, e.g. corn, rice, soy, buckwheat, millet, potato starch, cassava starch, amaranth or products whose gluten content does not exceed 20mg/kg - gluten-free wheat starch.

 

Gluten-free products are labelled with a crossed cereal ear.

Observance of gluten-free diet is monitored with serological markers: EmA and tTG.

Complications resulting from non-observance of the dietary recommendations:

1.         Fertility disorders

2.         Osteoporosis and osteomalacia

3.         Digestive system tumours – small intestine and oesophagus.

Zofia Grzenda-Adamek, MD

Katarzyna Przybyszewska, MD

Paediatric, Gastroenterology and Nutrition clinic

Polish-American Institute of Paediatrics CM UJ