Celiac disease is a disease with characteristic symptoms, but there are also atypical forms of it with a different symptomatology that are more difficult to diagnose. If you have any suspicions, you should check with your doctor and never start a gluten free diet on your own.
Celiac disease is characterized by the inflammation of the mucosa in the small intestine, which occurs after consuming gluten, a protein contained in wheat, barley and rye, and in products made with these cereals.
“It’s an autoimmune disease. These types of pathologies occur because the immune system, the body’s defenses against infections, attacks healthy tissue by mistake,” the National Health Service of the United Kingdom reports.
“In celiac disease, the immune system confuses the substances contained in gluten with a threat to the body and attacks them. This damages the small intestine and impairs the body’s ability to absorb nutrients from food,” the specialists added.
The causes of celiac disease are unclear
Miguel Ángel Martínez Olmos, member of the Spanish Society of Endocrinology and Nutrition (SEEN), states that today the causes of the disease aren’t clear.
“It’s believed that celiac disease is the end result of three processes that culminate in the damage of the intestinal mucosa: genetic predisposition, the individual’s immune system and environmental factors,” Martínez said.
“The mechanism by which some people with this genetic condition become celiac at a certain moment in their lives (children, adults even after 60 years of age) and others don’t isn’t yet well known. It’s like pressing a light switch,” Dr. Francesc Casellas Jordá, a digestive system specialist and member of the Spanish Society of Digestive Pathology (EDPS) said.
Typical forms of celiac disease are characterized by symptoms such as diarrhea, abdominal pain, swelling of the belly after eating, nausea and vomiting or weight loss.
But there are also atypical forms that produce non-digestive symptoms, for example, chronic iron deficiency anemia, menstrual abnormalities, repeated abortions, coagulation disorders and even psychiatric disorders. These cases are much more difficult to diagnose.
In general, to diagnose celiac disease, first-degree relatives are surveyed in search of the genetic condition that predisposes to this pathology.
A blood test is then conducted to detect the presence of celiac disease antibodies, particularly the glutaminase enzyme, and then a gastroscopy is carried out to perform duodenal biopsies.
However, sometimes there may be discrepancies between the results of the blood tests and those of the biopsies. In fact, a study published in 2007 in The New England Journal of Medicine estimated that in 10% of the cases the results of both tests didn’t match.
Sometimes complementary studies are necessary
When this happens, it’s necessary to resort to auxiliary diagnostic methods, such as flow cytometry, a test designed to study the cells of the gut and detect if there’s a certain type of white blood cell called gammadelta intraepithelial lymphocytes in the walls of the gut.
“The presence of these lymphocytes would be the first sign of the existence of celiac disease,” Dr. Julio Valle Muñoz, a digestive system specialist at the Toledo Hospital Complex and a member of the EDPS affirmed.
However, atypical forms of the disease showing cutaneous or neurological symptoms, for example, may take an average of two or three years to be diagnosed, according to data from the EDPS.
In fact, this organization emphasizes that 15% of cases of celiac disease are atypical forms difficult to diagnose.
In addition, there are other problems related to gluten that are not celiac disease, such as gluten allergy or sensitivity to this substance –still poorly known– which make people who suffer from it feel discomfort when taking gluten, without being celiac.
For all these reasons, it’s crucial that each case be studied and diagnosed by a specialist.
Some advises
As for celiac disease itself, Dr. Casellas Jordá recalls that he has “a very effective treatment, which is the complete and definitive exclusion of gluten from one’s diet. But no one should self-diagnose and exclude gluten from their diet without a reason or without having been checked and diagnosed by a specialist first.”
Similarly, Dr. Valle Muñoz stresses that you shouldn’t eat “a gluten-free diet without having seen a digestive system specialist who issues an accurate diagnosis of the disease, since it lasts for the rest of your life and it’s important that the diagnosis be safe.”
He also added that “the indiscriminate exclusion of gluten from one’s diet has become a fad, which makes diagnosis very difficult because we cannot assess the damage well. Even in certain cases we have to re-introduce gluten into the diet to conduct the studies.”
On the other hand, Dr. Martínez Olmos warns that, often, gluten-free processed products sold in supermarkets are “of a rather poor nutritional quality.”
Dr. Martínez Olmos explained that among their long lists of ingredients we can usually find saturated fats and significant amounts of sugar or salt, which ensures that the food in question has the desired texture and is tastier. Therefore, he points out that “it’s very important to carefully check the labels.”
Likewise, a study by researchers at Harvard University T.H. Chan School of Public Health in Boston (USA) determined that gluten-free diets aren’t only unbeneficial for the population without celiac disease, but may as well increase the risk of developing metabolic disorders.
The Spanish Society of Endocrinology and Nutrition advises that a healthy person’s diet be varied and balanced, without the need to dispense with gluten.
“There’s no scientific evidence that leads us to advise a gluten-free diet to healthy people,” Dr. Martínez Olmos concluded.
Date: November 7th, 2019
By: Elena Reinés | EFE
Source: SEEN | SEPD
Link: https://www.efesalud.com/enfermedad-celiaca-no-lo-se/
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