Celiac disease (CD) is a digestive disease in which the body’s immune defense system mistakenly attacks healthy intestinal tissues, altering the absorption of vitamins, minerals, carbohydrates, fats, and proteins contained in the foods we eat.
This disease damages the small intestine, whose function is to continue the process of digesting food coming from the stomach and absorb nutrients and water to take advantage of them and use them in the body.
Celiac patients do not tolerate a protein called gluten, which is found in cereals (wheat, oats, barley, rye), and when they eat foods that contain it, their immune system responds and damage occurs to the intestinal mucosa, according to the Clínica Universidad de Navarra (CUN).
The alteration of food absorption leads to malnutrition, even if adequate intake is maintained, and since there is a genetic component to celiac disease, this disease is more common in certain families, the CUN points out.
Three out of four celiac patients are undiagnosed.
Around 75 percent of those affected by this disease, which is more common in women and can also affect children, remain undiagnosed, according to the private health insurance company Nara Seguros, NS, citing data from the Federation of Celiac Associations of Spain, FACE.
This high percentage of undiagnosed people is due, for the most part, to the fact that for years celiac disease has been associated only with its classic clinical form of manifestation, but the recognition of other atypical forms, in which the patient has few or no symptoms, together with the greater and better use of available complementary tests, has revealed that there are different types of CD, according to FACE.
Gluten is a combination of proteins, mainly glutenin and gliadin, found in the seeds of many cereals such as wheat, oats, barley, or rye, according to NS.
This substance is present in foods containing cereals, such as pasta, pizza, bread, pastries, flour-coated products, and breaded preparations, among others.
When an individual with celiac disease consumes gluten, an immune reaction is triggered in their body, which damages the microvilli that line the small intestine, preventing it from properly carrying out its function of absorbing nutrients, they point out.
Although there is no cure for this condition, a strict gluten-free diet can help control it, allowing intestinal microvilli to regenerate and reducing abdominal inflammation and associated symptoms, according to NS.
A disease with very varied symptoms
The symptoms of celiac disease, both in childhood and in adulthood, are varied, they do not necessarily appear all at once, they may not be related to the digestive system, and there may even be no symptoms, thus making the diagnosis of this disease difficult, according to the specialists of this firm.
Some of the main symptoms are: nausea, weight loss, vomiting, diarrhea, noticeable abdominal swelling, growth retardation, anemia, depression and constipation, they add.
“Those who experience gastrointestinal symptoms may wonder if they might be celiac. In that case, it is important to consult a doctor to obtain a proper diagnosis and receive advice on the correct management of the disease,” says the health insurance company Nara.
An antibody test, an intestinal biopsy, and a gluten-free diet for at least six months will allow for final confirmation of this pathology, they point out.
“Probably the only pathognomonic sign (exclusively characteristic) of celiac disease is dermatitis herpetiformis,” Pablo Caballero, a pharmacist in the scientific dissemination area of the General Council of Pharmaceutical Colleges of Spain, explains to EFE.
“Dermatitis herpetiformis usually occurs in young patients, but is rare in children and is more common in women than in men,” according to this pharmacist.
He explains that “this disease manifests itself as an intensely itchy rash that can be confused with atopic dermatitis and primarily affects the elbows, knees, shoulders, neck, and trunk, and more rarely can also appear on the oral and genital mucosa.”
“If a patient presents this symptom, the diagnosis of gluten sensitivity can be confirmed, although this does not mean that all patients with gluten sensitivity have this symptom since it is estimated that only between 10% and 20% of celiac patients develop dermatitis herpetiformis,” explains Caballero.
Although the antibiotic Dapsone can be used to treat this disease, it resolves when gluten is eliminated from the diet, says Caballero.
“Not all celiac patients have the same symptoms, nor with the same intensity. When a diagnosed patient does not report symptoms, it is possible that the damage to the gastrointestinal mucosa has not become severe enough to generate the classic symptoms: greasy stools, abdominal pain, flatulence, or weight loss,” he points out.
It is also common to have low-intensity symptoms, which disappear when following a gluten-free diet and which the so-called asymptomatic patients acknowledge went more or less unnoticed, such as flatulence, mild stomach discomfort, or loose stools, according to Caballero.
“Even if there are hardly any symptoms, diagnosis is important because one of the main risks of uncontrolled celiac disease is that damage to the gastrointestinal mucosa increases the risk of malignancy, that is, it produces a higher risk of developing cancer,” according to this pharmacist.
Furthermore, “in the absence of symptoms, there may be problems of poor intestinal absorption that can cause nutritional deficiencies,” he concludes.