Causes and Symptoms
In healthy people, food is broken down into its component parts in the small intestine and passes through the mucous membrane of the small intestine into the body. This process is called absorption. Structures called intestinal villi play an important role in this. They look like tiny protrusions and act to make the surface of the intestinal mucosa bigger so that the largest possible amount of nutrients can be absorbed and transferred into the blood.
In coeliacs, gluten triggers inflammation in the small intestine and damages the mucosa. Depending on the degree of severity of the condition, the intestinal villi reduce in size either partially or fully. As a result, the important nutrients from food cannot be absorbed properly any more and are distributed throughout the body. Instead, the nutrients are simply excreted. Nutritional deficiencies occur that can trigger a range of health problems. Particularly large signs of deficiency are those due to from the negligible intake of the fat-soluble vitamins A, D, E and K, the minerals calcium and iron, trace elements such as fatty acids, and proteins.
Coeliac disease can manifest itself in a variety of ways. Typical symptoms include constipation, flatulence, diarrhoea, nausea, vomiting, weight loss, swollen abdomen, osteoporosis, bone pain, pasty skin, inflammation of the oral mucosa, depression, irritability, tiredness, loss of appetite, nutrient deficiency and growth deficiency in children.
The disease pattern can be very varied and the symptoms can be rather unspecific, because they generally do not all occur at the same time. This means that coeliac disease is often not spotted immediately. If the disease is noticed too or not treated by a gluten-free diet, signs of deficiency and chronic infectious diseases can develop, leading to a weakening of the whole body.
Typical coeliac disease
This form of coeliac disease can manifest itself as early as the first year of life, after the infant has started to receive solid food. Typical symptoms are diarrhoea, failure to thrive, bloated stomach and nausea.
Atypical coeliac disease
This form of coeliac disease often does not occur until adulthood and mainly manifests itself in rather unspecific symptoms such as iron deficiency, tiredness, depression and osteoporosis.
Silent coeliac disease
Sufferers have few or no symptoms. This form of coeliac disease is diagnosed via a blood test with evidence of antibodies. The intestinal villi have already reduced in size.
Latent coeliac disease
In the case of latent coeliac disease, no symptoms manifest themselves. However, antibodies are detectable in the blood. The intestinal villi have not yet reduced in size.
If coeliac disease is suspected, a blood test should be taken first (anti-tissue transglutaminase IgA). If antibodies to the reserve protein gliadin are found in the blood, it is necessary to take a tissue sample via a colonoscopy to finally ensure the diagnosis is correct. At present these methods are the only sensible ways to make a certain diagnosis of coeliac disease.
If the diagnosis is certain, a gluten-free diet must be followed. This is the only sure form of treatment for sufferers. By keeping to a gluten-free diet, the intestinal villi regenerate themselves again and the symptoms reduce. Nutrients are absorbed by the body better and the person's overall wellbeing is improved.
Even small amounts of gluten can damage the intestinal wall again. The degree of sensitivity to gluten and the intensity of the symptoms vary from person to person. In some people there are hardly any symptoms if foods containing gluten are accidentally eaten. Other people react even to the slightest traces of gluten with pronounced symptoms. It is now possible to support this change in diet, because there is now a large variety of gluten-free foods available.
DZG Deutsche Zöliakie Gesellschaft e.V.
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ÖAZ Österreichische Arbeitsgemeinschaft Zöliakie
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