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by Anna Maria Castellazzi 01 April 2015 What is itCeliac disease is a chronic enteropathy (chronic inflammatory disease of the gastrointestinal tract), which develops in genetically predisposed individuals, whose immune system abnormally recognizes gluten proteins, a polypeptide contained in various cereals such as wheat, barley, rye and oats.
It is characterized by intestinal lesions, such as atrophy of the villi, hypertrophy and hyperplasia of the crypts and marked inflammatory infiltrate both in the epithelium of lining and in the lamina propria of the intestinal wall, which hinder the absorption of nutrients and improve by eliminating from the diet the gliadin of wheat and the prolamins of other cereals (barley and rye).
How do we notice it?
The most common symptoms of this condition include diarrhea, abdominal distention and pain, weight loss, fatigue and malnutrition. The heterogeneity of the symptoms makes it possible to classify the celiac disease in different ways: "classic or symptomatic" characterized by diarrhea and malnutrition, "atypical or asymptomatic" which does not present symptoms of the gastrointestinal tract and celiac disease defined as "silent" when the enteropathy occurs found in apparently healthy patients.
What is the size of the problem?
The Ministry of Health has estimated that potentially celiac subjects in Italy could be around 600 thousand, but to date only 60 thousand have been diagnosed.
Diagnostic tests
The non-invasive diagnostic tests are based on the research, in the serum of: anti-gliadin antibodies (gluten protein) called AGA, anti transglutaminase tissue antibodies, enzyme that converts glutamine residues present in gluten into glutamic acid, favoring protein presentation to immune cells. In doubtful cases, EMA tests can be performed, which evaluate anti-endomysium antibodies, using monkey esophagus tissue as a substrate.
If serological tests are positive, a duodenal biopsy is performed which can demonstrate damage to the intestine: villous atrophy, crypt hypertrophy and lymphocytic infiltrate.
How is it treated?
The only therapy currently available for celiac disease is the total and permanent exclusion of cereals and gluten-containing derivatives from the diet.
For celiacs it is essential to respect the diet without gluten-containing foods, in order to obtain remission of the signs and symptoms of the disease, thus allowing the intestine to regain its normal morphology and absorbing function. Properly following a strict gluten-free diet involves important changes in the lifestyle of the subject. The intake of packaged gluten-free foods can also lead to an increase in blood cholesterol levels.
What can you eat?
Celiac patients can easily consume many foods: all types of meat, cheese, fruit, milk and derivatives, legumes and vegetables, millet, corn, olive oil, peanut, sunflower and corn; fish, polenta, potatoes, rice, sesame, soy, tapioca, eggs and all those foods for which the absence of gluten is certified in the various production phases. As for oats, the experimental evidence indicates that the vast majority of celiacs can tolerate it, but as a precaution it is good not to include it in the gluten-free diet especially due to the risk of contamination.
To know more
1. Kupper C. Dietary guidelines and implementation of celiac disease. Gastroenterology. 2005; 128 (4 Suppl 1): S121-7.
2. Ministry of Health: www.salute.gov.it.
3. Saturni L, Ferretti G, Bacchetti T. The gluten-free diet: safety and nutritional quality. Nutrients. 2010; 2 (1): 16-34
4. Torres MI, López Casado MA, Ríos A. New aspects in celiac disease. World J Gastroenterol. 2007; 13 (8): 1156-61.
AnnaMaria Castellazzi, PhD
Specialist in General and Clinical Pathology
Specialist in Food Science
Department of Clinical-Surgical, Diagnostic and Pediatric Sciences
The University of Pavia
mail: annamaria.castellazzi@unipv.it