Celiac Disease: What does it Consist Of?

A gluten-free diet is the main treatment for people with celiac disease. What is this disease?

Celiac disease is a permanent gluten intolerance. It results from damage in the mucosa of the small intestine that causes inadequate food absorption. In addition, it can cause stunted growth, diarrhea or vomiting. The factors that determine its development are both genetic and environmental.

Celiac disease: what is gluten?

Gluten is the protein found in products such as wheat, barley, rye, and oats. Molecules known as prolamines are responsible for this disease. They have a different name depending on the food they are found in. These names are:

• Gliadin is the prolamine present in wheat.
• That of barley, hordein.
• Secalin is the molecule present in rye
• The toxicity of oat prolamine, known as avenin, is controversial.

Diagnosis of celiac disease

It’s important to know the diagnostic mechanism to understand how celiac disease can occur. If this disease is suspected, some factors must be considered such as gastrointestinal symptoms and whether or not there are relatives with the disease. In addition, a doctor can perform serological tests.

Health care professionals diagnose this in adults by using an intestinal biopsy. In order to perform the intestinal biopsy, a sample of the intestinal mucosa is taken by endoscopy, analyzed and assessed based on the Marsh classification.

Epidemiology

In Europe, one percent of people have celiac disease; it occurs more frequently in women than in men. In Spain, 1/118 children and 1/389 adults have celiac disease.

The two age groups that most commonly have celiac disease are: in childhood (before the age of six) and people in their 40s and 50s.

Types of celiac disease

1. Classic or typical form

Symptoms are related to abnormal intestinal absorption. It usually occurs between six and 18 months of age, after weaning and following the introduction of food containing gluten. However, it’s been found that delaying the introduction of gluten doesn’t reduce the risk of suffering from this disease.

2. Atypical form

Symptoms aren’t related to the intestinal tract with this form. In fact, there are very few or no gastrointestinal symptoms. In general, older children and adults have atypical forms. Common characteristics of abnormal absorption are absent.

3. Silent or asymptomatic form: celiac disease

Individuals with a family history of celiac disease and patients with associated autoimmune or genetic diseases have this type. In these cases, the affected individuals test positive and the intestinal mucosa is involved but they don’t have symptoms.

4. Latent form

This form typically occurs in individuals who have asymptomatic celiac disease and eat gluten. The serology is positive, but there’s no atrophy in the intestinal mucosa.

5. Potential form

Individuals who show positive results in genetic and serological tests but have never been diagnosed with the disease fall under this category. The condition of the intestinal mucosa is normal or slightly abnormal.

6. Refractory form

This form of celiac disease is defined by the presence of malabsorptive symptoms and atrophy of villi that persist after a year of eating gluten-free. 

So far the only dietary treatment is eating a gluten-free diet. For this reason, it’s very important to differentiate between foods with gluten from those without.

Although at first it may seem restrictive, this diet includes most food groups. Foods that don’t contain gluten are:

• Most milk and dairy products.
• Fresh, canned or frozen meat, fish and seafood.
• Eggs.
• Fruits, vegetables, and tubers.
• Dried fruits.
• Oil, wine vinegar, salt, and spices.
• Sugar and honey.
• Wines, sparkling drinks, coffee beans or ground coffee and tea.
• Cereals without gluten: rice, corn, and its derivatives.

In general, an individual with celiac should eliminate wheat, rye, barley, oats and all cereals and flours made with these ingredients from their diet. 

In addition, people with celiac disease need to read labels to avoid involuntary consumption of gluten. However, there’s a wide range of products labeled ‘gluten-free’ that shouldn’t contain more than 20 ppm of gluten.

Sensitivity to non-celiac gluten

Sensitivity to non-celiac gluten is a newly diagnosed disease whose prevalence is estimated up to ten times higher than that of celiac disease. In this instance, non-celiac patients have gluten dependent symptoms. These individuals should avoid gluten. However, a diet low in FODMAPs could also be an effective treatment.