Understanding Celiac Disease: Causes, Symptoms, and Management
Celiac disease, or sprue, is a form of gluten intolerance. The small intestine consists of thousands of folds and swells, so-called villi, which are covered with millions of tiny hairs. This increases the inner intestinal surface by 300 and the area where nutrients are exchanged to 100 to 200 square meters. A highly effective mechanism that is also prone to disease. With this trick, nature provides a considerable exchange surface in a small space. Conversely, this also shrinks quickly when the villi change pathologically, leading to food intake and utilization problems. This is precisely what happens with celiac disease.
What is celiac disease, and how does it show up?
Celiac disease is a chronic disease of the small intestine. In celiac disease patients, the wrong amino acid is incorporated into a body protein to detect enemies. As a result, gluten, a protein in cereals, is bound to these immune cells for longer and triggers an unnecessary foreign body reaction.
However, the immune cells not only attack the gluten, they also damage the intestinal mucosa. Due to the gluten intolerance, the bulges in the small intestine shrink. As a result, fats, sugars, proteins, vitamins, minerals and even water can no longer be adequately absorbed by the body. The lack of these substances, in turn, leads to a variety of symptoms and complaints – no two cases of illness are identical.
Celiac disease, sprue or gluten intolerance?
In the past, a distinction was made between celiac disease and sprue: if the disease occurred in childhood, it was called celiac disease; if it was diagnosed in adulthood, it was called (native) sprue. Today, we only speak of celiac disease since it is the same disease and not, as was assumed at the time, two different disorders.
The terms gluten intolerance or gluten intolerance are also common. These are rather generic terms: in addition to celiac disease, gluten intolerance can also mean gluten sensitivity. In addition to digestive disorders, symptoms can also occur that are unusual for celiac disease, such as migraines, depression or muscle pain. Gluten sensitivity can be sudden and temporary.
A classic form of celiac disease
The classic symptom is diarrhoea: the undigested fats are excreted in the stool, making it bulky and foul-smelling. Those affected suffer from flatulence, lose weight and are prone to iron deficiency and anaemia. Muscle wasting, water retention, increased skin pigmentation and hair loss can all occur. Various signs of vitamin and calcium deficiency, such as B. Coagulation disorders and osteoporosis, occur. After a longer course, insomnia, fatigue or depression can also be possible symptoms.
Symptoms first appear in children when they start feeding porridge with grain products – usually from the age of 6 months. Babies have no appetite, abdominal pain, bloated tummy, and frequently pass large amounts of foul-smelling stools. They no longer gain weight appropriately and can develop signs of anaemia and dehydration. Typical are “tobacco bag buttocks” because the fat reserves are broken down in the buttocks, and a sullen, tearful facial expression is a sign of irritability to the point of a personality change. It is not uncommon for child development to stagnate or even go backwards.
Atypical forms of celiac disease
Insidiously, almost half of the patients show no gastrointestinal symptoms. Instead, the disease may only manifest itself through one or more of the following symptoms:
- Skin changes (dermatitis herpetiformis Duhring)
- Iron deficiency, short stature
- gum shrinkage
- joint problems
- liver inflammation
- osteoporosis
- Depression, irritability, fatigue
- limited fitness
- in women to frequent miscarriages or infertility
These atypical courses are challenging to recognize, and it is not uncommon for patients to have had an odyssey of years before they are diagnosed with celiac disease.
What is gluten, and what effects does it have?
Gluten is a sticky protein made up of the proteins prolamin and glutelins. It is of central importance for the baking properties of flour and is found above all in the grain types wheat, spelt, rye, barley and oats – and thus in numerous foods.
Gluten contains gliadin, which can provoke a response from the immune system, causing antibodies to form. These are directed against the intestinal mucosa and lead there – even in the most minor amounts – to inflammation and, in the long term, to severe damage. The villi flatten out, the surface shrinks, and insufficient digestive enzymes are produced. Due to these processes, one also speaks of a gluten-sensitive enteropathy (= bowel disease).
As a result, the body can no longer absorb enough nutrients, leading to deficiency symptoms. If the disease lasts longer, the constant inflammatory reactions can lead to an increased risk of cancer (lymphoma).
