Celiac Disease in simple words.

What is celiac disease?
Celiac disease or gluten enteropathy, is a chronic disease of the small intestine caused by the toxic effects of gluten, a protein contained in wheat, barley, rye and oats, in genetically predisposed individuals. In these subjects, the gluten triggers immune mechanisms which would ultimately result in the damage (atrophy) of the small intestinal’s mucosa, thereby affecting the normal absorption of nutrients, vitamins and minerals. Therefore celiac disease is considered an autoimmune disease.
How much common disease is it?
Celiac disease is much more common now than in the past. It is estimated that in the US and Europe the incidence is 1 in 100-200 persons. However, the majority of sufferers remain undiagnosed. Celiac disease is more common in first degree relatives of patients (10%), in individuals with other autoimmune diseases such as diabetes mellitus type I, autoimmune thyroiditis, psoriasis, dermatitis herpetiformis, autoimmune hepatitis, and finally in people suffering from various syndromes such as Down’s syndrome, Turner’s syndrome, Williams syndrome.
When does it occur and what are the symptoms
Celiac disease can occur at any age, from infancy, since gluten is introduced in the diet until the age of 60 years or higher. The symptoms in infancy and up to two years include diarrhea, vomiting, anorexia, rarely constipation, weight stagnation, abdominal distension, drowsiness or irritability, malnutrition.

In older age until adolescence, include diarrhea or constipation, anorexia, stagnation or weight loss, iron deficiency anemia, fatigue, growth retardation (short stature), delayed puberty, enamel hypoplasia substance of teeth, osteoporosis or osteopenia.

In adults, usually the symptoms are atypical or nonspecific (and this is why diagnosis is delayed) as dyspeptic or irritable bowel symptoms (spastic colitis), chronic iron deficiency anemia, increased liver enzymes (transaminases), osteoporosis, dermatitis herpetiformis, mood disorders (depression or dysthymia), disorders of menstruation, infertility. However most of celiac patients are asymptomatic or have very mild symptoms, thus remain undiagnosed for many years.

How is it diagnosed;
Originally diagnosis is made by searching the blood of specific antibodies such as anti-tissue transglutaminase (Ab t-TG) and against endomysial (EMA) whose title is increased. Prerequisite for the evaluation of these antibodies is that the immunoglobulin A (IgA) of the patient is normal. Confirmation of the disease is made by biopsy of the small intestine (by gastroscopy), where partial or total atrophy (flattening) of the villi is found in multiple samples.
How is it treated?
The treatment of celiac disease is made by lifetime strict gluten-free diet, ie foods that contain wheat, barley, rye and oats. Indicative prohibited products are foods containing flour (bread, rusks, pies, pizzas, biscuits, pastries, cakes, etc.), pasta, some meats, canned goods, mayonnaise, mustard, sauces, creamy cheeses, some drinks ready , beer, etc.

There is a wide variety of foods without containing gluten by nature such as fresh meats, poultry, game and fish, milk and its products (yoghurt, feta cheese, hard yellow cheese), all fresh vegetables, pulses, rice, corn, fruit, oil. These foods are a valuable source of nutrients for the diet of people with celiac disease as long as the preparation is done at home. When it is a pre-prepared or processed food, the possibility that gluten is included in the processing is large. For this reason special attention should be always payd in the consumption of these foods. Foodstuffs which indicated that they do not contain wheat, it is not safe, because it may contain gluten from other grains (barley, rye, oats). Also, some medicines may contain as gluten excipient.

Indicating on the label that the product is gluten-free, ensuring the patient.

Celiac disease after treatment is started.
After 15 days from starting glutten-free diet, there is a dramatic improvement of symptoms, particularly significant weight gain and few months extra height is also gained (as long as the disease is diagnosed before puberty). Blood tests return to normal and the title of antibodies decreases gradually until restored to normal, about 1 year’s time. Within 1 to 2 years from the start of the diet recovery and lesions (atrophy) of the villi of the small intestine is observed.

The gluten-free diet must be strictly enforced and adhered to for life. The intake of even small quantities of gluten have lasting effects on the sufferer’s health, such as risk of developing iron deficiency anemia, growth retardation, infertility and increased risk of malignancy (bowel lymphoma) compared to the general population. A strict gluten-free diet reduces these risks.

Monitoring of patients with celiac disease.
After the diagnosis of celiac disease and the start of the diet, control of antibodies against tissue transglutaminase (Ab t-TG) should be made, the title of which will be reduced gradually until they return to normal. This audit is performed by the treating physician, initially every six months and when Ab t-TG become normal, then control can be done every year. Also, at least once a year, ferritin (a measure of iron stores in the body) should be checked .
Check of the patient's family members
Immediately after the diagnosis of celiac disease in the affected child or adult, other members of the family (parents, siblings, children) should be checked as the possibility of a family member to suffer from celiac disease is 10%, even if the member has no symptoms.