Celiac disease has long been considered a rare disease, which is actually the classic form. The classic form is accompanied by severe inflammation of the digestive tract, severe malabsorption of nutrients, low body weight, sideropenic anemia, retardation in physical and psychological development and is generally observed immediately after birth. But due to the increasing amount of gluten in wheat grains (agronomists say that it is up to 50 times higher than 30 years ago), somewhat milder symptoms, so-called latent celiac disease, begin to develop in genetically predisposed people. Today, celiac disease is classified as a systemic, multiorgan autoimmune disease that occurs in genetically predisposed individuals after ingestion of gluten through food or drink. What are all the symptoms and/or diseases associated with celiac disease?

*elevated liver enzyme values (if other liver diseases are excluded)

*Hashimoto’s thyroiditis and Graves’ disease

*osteopenia/osteoporosis

*unexplained ataxia or peripheral neuropathy

*infertility, premature menopause

*chronic fatigue syndrome

*psoriasis

*mood changes

*migraine

How is celiac disease diagnosed?

The first line tests are genetic tests, HLA DQ2/DQ8 testing. They determine with high probability (almost completely) genetic mutations in patients and tell us if there is a genetic predisposition to celiac disease. If mutations are proven, they are classified into 5 groups. The degree of damage to the structure of enterocytes and the severity of the clinical picture decrease with the number of groups, i.e. the most severe clinical picture and the highest degree of damage is given by group 1, the mildest (very often and unnecessary for treatment) by group 5.

Second-line tests are serological, measuring antibodies. It is recommended to measure class A antibodies namely tTG IgA and EMA IgA. In addition, measurement of total IgA antibodies is advised in order to avoid false interpretation of results in patients with total IgA antibody deficiency. It should be remembered that, like all other immunological diseases, this disease can be “seronegative”, so that a good antibody titer result does not rule out the disease. Correlation of the antibody titer in the patient’s serum and the degree of damage to the enterocyte structure was also proven.

Third-line tests: endoscopic procedures (gastroscopy) and taking pathohistological samples to prove celiac disease. Under the microscope, the damaged structure of the enterocytes can be seen extremely well.

Therapy

Therapy requires the exclusion of gluten from the diet. In doing so, you should consult with a nutritionist because wheat is rich in all vitamins of the B group and often patients on a gluten-free diet have a reduced intake of these vitamins. Deficiency of folate and vitamin B12 occurs most often during the gluten-free diet, so supplementation of these vitamins can help reduce (stop) depression or anxiety, which can occur in a milder form during the gluten-free diet. The normalization of the structure of the duodenal mucosa takes an average of 6-24 months, sometimes longer. After establishing the diagnosis by endoscopic or serological means, the control should be after 2 years, of course if the clinical picture of the patient is better, if necessary even earlier.

Celiac disease or gluten intolerance?

As I already wrote, celiac disease is the first immunological, multisystemic disease that seriously disrupts the structure of enterocytes and it takes (often) a long period for the structure to recover. Gluten intolerance is not an immunological disease, but a condition where discomfort occurs in the digestive tract when eating foods rich in gluten. The symptoms disappear a few days after stopping gluten intake and there is no damage to the structure of the enterocytes.

Medicine underestimates the presence of latent celiac disease in the modern world, estimates are that for every 100 people there is one with latent celiac disease. Therefore, if someone in your family has celiac disease, get yourself tested. If you experience problems with your stomach, visit your doctor. If your symptoms do not go away, consider whether you are one of the 100 people with latent celiac disease and get tested.

I wish you good health and keep it, maintain it, nurture it.

spec ph Božić Milan, med biochemist