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Celiac disease

What is celiac disease?
Celiac disease is the hereditary chronic condition characterized by susceptibility to damage of the intestinal mucosa with gluten, a protein contained in cereal plants. Gluten-free diet is required to manage celiac disease.

What contains the protein gluten, which is hazardous for celiac disease patients?
Gluten is found in rye, wheat, oat, barley, and in products that contain them (flour, kasha, boiled sausages, mayonnaise, wafers, etc.).

What processes are impaired by gluten in celiac disease?
The most affected process is nutrient absorption in the small intestine. The small intestine is lined with villi, which under the effect of gluten undergo atrophy up to complete smoothing and discontinue their normal functions. However, it is due to this lining that a number of substances including milk sugar lactose and mushroom sugar trehalose are digested. If they are not, their large incompletely digested fragments, which may be allergenic, enter the circulation and thus may cause allergic responses. Another role of villi is to increase the working area of the small intestine and its absorbing ability. In the absence of villi because of their leveling off, a significant part of essential nutrients is not absorbed. The unabsorbed nutrients are decomposed in the lower segments of the bowel to cause fermentation and gas formation. Altogether, this leads to endocrine disorders, because the duodenum, which is a part of the small intestine, performs some endocrine functions. The composition of intestinal microflora changes, i.e., dysbiosis develops. The poisoning of the organisms with toxic products of inappropriate digestion and the insufficient nutrient supply lead to inadequate brain supply with nutrients. The patient experiences headaches, irritability, and other mental symptoms. In some cases, damage to the hypophysis in children results in growth retardation. Altogether, this suggests that gluten is very hazardous to celiac disease patients.

How strict should be gluten-free diet for celiac disease patients?
Gluten-containing products must be completely excluded from the diet of celiac disease patients. If such diet is strictly adhered to, the patient will return to normal life. However, if even as little as 100 mg of gluten is ingested, the disease will relapse, however, it may happen not at once. Such episodic violations of the diet are poorly tolerated by the intestine; and so, all manifestation of celiac disease will develop again.

What is the prevalence of celiac disease?
Until recently, Russian sources rated celiac disease as a rare condition (1-2 children out of 10000, with no estimates concerning adults). However, present time foreign sources provide evidence about much greater prevalence, 100-300 cases per 10000 population. Recent large-scale studies suggest that other diagnoses were made for celiac disease patients earlier.

Who may develop celiac disease?
As it was stressed above, celiac disease develop only in subjects who have the hereditary predisposition to it. It was believed earlier that celiac disease occurs only in children and subsides in adolescents. However, even if its symptoms disappear, intestinal damage persists. Therefore, gluten-free diet must still be followed by adults, otherwise, serious complications may develop.

When the initial symptoms of celiac disease start to appear?
Often, the disease manifests itself 4-8 weeks after products that contain gluten (semolina, porridge, or oat floor) have been introduced to baby meal. The disease may also start from the second year of baby's life or, sometimes, much later. The triggers of the realization of the genetic defects in such cases are intestinal or other infections, stress, etc.

What are the symptoms of celiac disease?
Because of the variability of the symptoms of celiac disease, its diagnostics is difficult, and it often confused with other diseases of the gastrointestinal tract as well as other systems. When no treatment is provided, different symptoms succeed each other. For example, those that often develops in children aged 3 to 7 may subside to be followed by other problems. Celiac disease is suspected when three main or two main and two additional symptoms are observed.
The main symptoms of celiac disease include the following:

  • · abundant, foul, light-colored of "multicolored" loose, foamy or clayey, poorly washed away stool two or more times daily;
  • abdominal enlargement (swollen abdomen);
  • abdominal pain usually localized near the navel, experienced in the range from dull diffuse sensation to acute attacks, and subsiding spontaneously or after defecation;
  • vomiting, which may occur occasionally or daily;
  • appetite loss or gain or alternating increased and reduced appetite;
  • growth retardation;
  • food allergies including atopic dermatitis, respiratory allergosis, bronchial asthma, neurodermatosis or eczema;
  • signs of calcium and phosphorus deficit, such as bone pain (in night or upon exercise), bone fracture upon inadequate trauma, tooth enamel lesions, caries, etc.;
  • irritability and aggressiveness;
  • bad sleep and walking and talking in nighttime;
  • anemia;
  • intestinal dysbiosis;
  • fatty acids and saponified fatty acids are detected in a series of biochemical tests of feces;

  • The additional symptoms of celiac disease include:
  • frequent acute respiratory infections, more than thrice a year;
  • fatigue;
  • poor memory;
  • persistent constipations;
  • muscular weakness;
  • relapsing muscular spasms;
  • faints;
  • relapsing paresthesias (finger and toe numbness);
  • frequent nasal, juvenile uterine, and other hemorrhages;
  • menstrual cycle disorders;
  • follicular hyperkeratosis;
  • impaired nocturnal vision;
  • skin itching;
  • hair loss or even alopecia;
  • vitiligo (unpigmented skin spots);
  • relapsing stomatitis;
  • hypoproteinemic edema;
  • rectal prolapse;
  • type I diabetes, polyendocrinopathy, connective tissue diseases, and/or tumors of the intestine or other organs among relatives;
  • reduced blood albumin, cholesterol, lipids, micro- and macroelements, and/or vitamins

  • In what cases a child must be examined for celiac disease?
    Current Russian and foreign literature recommends to make examination for celiac disease when the following is observed:
  • chronic diarrhea or regular diarrhea and vomiting;
  • persistent abdominal pain and unstable stool (alternating diarrheas and constipations);
  • delayed puberty;
  • two or more bone fractures upon light traumas, persistent pain in bones, and/or multiple caries (osteoporosis);
  • long-standing furunculosis of stomatitis;
  • endocrine disorders including type I (insulin-dependent) diabetes mellitus, autoimmune thyroiditis or thyroid gland inflammation;
  • persistent skin lesions;
  • diseases having unknown causes, such as autism, multiple sclerosis, or connective tissue diseases (arthritis, vasculitis etc.);
  • chronic miscarriage; and
  • epilepsy.

  • Can a physician determine celiac disease for sure?
    To make the exact diagnosis, a physician must follow the "Standards for Diagnostics and Treatment of Digestive Organs" authorized by the Minister of Health of the Russian Federation by Order No. 125 of 17.04.1998. The following is mandatory:
    Laboratory tests:
  • Clinical blood analysis
  • Serum Iron
  • Clinica urine analysis
  • Feces analysis
  • Bacteriological feces analysis
  • Histological examination of biopsy sample
  • Serum immunoglobulins
  • Blood cholesterol
  • Blood protein fractions

  • Instrumental investigations:
  • Ultrasonic examination of the liver, bile ducts, and pancrease
  • Double esophagogastroduodenoscopy and targeted autopsy of the mucosa of the duodenum or small intestine (modern endoscopic instruments make it possible to make autopsy at any age!).

  • What hazards are associated with celiac disease?
    Propper treatment allows a patient leading normal life, the only limitation being gluten-free diet. Untreated celiac disease may lead to the development of a number of diseases, which include:
  • Type I diabetes mellitus
  • Autoimmune thyroiditis
  • Chronic adrenals failure (Addison disease)
  • Severe connective tissue diseases (scleroderma, rheumatoid arthritis, etc.)
  • Boldness (alopecia)
  • Autoimmune hepatitis
  • Epilepsy
  • Intestinal cancer (the risk of oncological diseases increases more than100-fold!)

  • By addressing LENMEDCENTER you may save you health. If your diagnosis is yet to be made, doctors at LENMEDCENTER will carry out appropriate examinations to determine the presence or absence of the disease. The diet will be devised with consideration of not only the exclusion of gluten but, also, the availability of all nutrients and microelements essential for babies and adults. Even for adults it is hard to restrict themselves, and this still more true for children. They do not always recognize the connection between what they eat and what they suffer from. Psychological training at LENMEDCENTER performed individually and in groups will teach to adhere to diet and not to regard celiac disease as one's fault.

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