Celiac disease symptoms

Celiac disease is a syndrome characterized by a disturbance of intestinal absorption.

Celiac disease is a congenital disease of the gastrointestinal tract, which is based on gluten protein intolerance. Such protein is found in cereals( oats, wheat, barley, rye).

This syndrome was first isolated by the English physician S. Gee in 1888. He first identified a syndrome characterized by growth retardation, diarrhea and malnutrition in children with intestinal diseases. He believed that in such cases the colon is affected, in connection with which the name celiac affection - celiac appeared. In 1908, a similar disease was described, called intestinal infantilism, and in 1909 - severe chronic insufficiency of digestion. Only in 1950, Dutch pediatrician W. Dicke, for the first time, as an important cause of chronic intestinal disease of children, described the inability to metabolize gluten in some cereals( wheat, rye, barley, oats).

Causes of the disease

At the moment, the causes of the disease are not established, it is believed that it is of an autoimmune nature.

Pathology is of a family nature, transmitted by an autosomal recessive type with incomplete penetrance of the pathological gene. About 80% of patients are carriers of HLA-B8 antigen. The relative risk of celiac disease for individuals HLA-B8 is 8-9 times higher than for those who do not have this antigen. However, this does not mean that the B8 antigen directly contributes to the disease.

Whatever the mechanism causing primary damage to the mucosa, with a long enough intake of food containing gluten, characteristic changes in the jejunum develop( atrophic ichnitis).It consists in shortening and complete disappearance of villi with damage to surface cells. A sharp decrease in the surface area of ​​absorption, a decrease in the activity of enzymes that perform membrane digestion, accumulation of products of incomplete cleavage of nutrients with intestinal growth of the microbial flora lead to a change in the acidity of the food lump to the acidic side, disrupt the transport of water, electrolytes and protein, as well as their enhanced excretion from the circulatorychannel. Insufficient absorption of fatty acids of food and bile acids can lead to increased secretion of intestinal juice, motor activity of the intestine, which leads to a pronounced increase in the volume of feces( polyphecal).Absorption, as well as loss of protein, fats, electrolytes, minerals and vitamins contribute to the formation of dystrophy, anemia, rachitis-like condition, polyhypovitaminosis.

Signs of the disease

The first manifestations of the disease are recorded after the introduction of complementary foods containing cereals. The child has a fast, thin, foamy stool that has a sharp odor. The baby grows thin, becomes flabby and pale. His tummy grows. Treatment with antibacterial drugs and enzymes does not have a positive effect.

The disease develops gradually after the introduction into the diet of the child of gluten-containing products( semolina, bread, milk mixtures containing wheat, oats, barley, rye flour).The first signs of the disease - changes in the mood of the child, lethargy, lack of appetite and weight gain, the appearance of a loose stool with an increase in the number of feces with a constant frequency. During this period, approximately half of the children diagnosed with intestinal infections, usually not confirmed by bacteriological analysis of feces. In this connection, the child is given repeated massive courses of antibacterial therapy, which promote the development and aggravation of intestinal dysbiosis. After 1,5-3 months after the beginning of the use of gluten-containing products, the main signs of celiac disease develop in most patients - general exhaustion, large abdomen and abundant, putty, with a fleshy sheen stinking stool, the weight of which can reach 1 to 1.5 kg per day. The old unhappy facial expression, thin limbs in combination with a sharply enlarged abdomen give the sick children a characteristic "spider" look. The remaining symptoms of celiac disease can be considered the result of inadequate absorption in the intestine, while the range of clinical manifestations of celiac disease is extremely wide.

The most constant signs of the disease are: stunted growth and weight gain, decreased muscle tone, delayed rates of psychomotor and speech development, diarrhea, vomiting, decreased appetite, unstable well-being, abdominal pain, prolapse of rectum, osteoporosis with the possibility of spontaneous fractures of bones,later teething with a tendency to caries, pallor and dryness of the skin and mucous membranes, the phenomenon of hypopolyvitaminosis( uneven pigmentation of the skin, inflammation of the mouth, inflammation of the tongue, impotencemagnetizations and brittle hair, bruising), swelling, degenerative changes of the internal organs. In the course of the disease, 3 phases of its development are distinguished: latent( latent) phase of bright clinical manifestations( acute, midsection phase) and chronic phase. The first signs of the upcoming improvement are a decrease in the amount of feces, the cessation of diarrhea. Quite quickly, the body weight increases, neuropathic symptoms, signs of hypovitaminosis, anemia gradually disappear, and osteoporosis is slowly eliminated.

Diagnosis of the disease

The disease is diagnosed on the basis of the examination data, the history of the disease, the characteristic type of the patient. The child's condition improves significantly against the background of a gluten-free diet. In some cases, celiac disease is confirmed by a biopsy of the small intestine mucosa.

Celiac disease is characterized by a different degree of anemia with a change in the shape and size of red blood cells. In some patients, a decrease in the number of platelets, acceleration of ESR, a number of white blood cells can both increase and decrease. Changes in urine tests are characteristic in most children of the appearance of a large number of salts( oxalates), increased excretion of protein and carbohydrates. Some children in the acute phase of celiac disease show increased fluid intake combined with an increase in the amount of urine released( polydipsia - polyuria syndrome) with a low relative density of urine - 1000-1004.In the study of stool, a large amount of fat is noted. In most cases, the intestinal dysbiosis of one degree or another is revealed. Analysis of the results of biochemical blood tests shows that changes in the protein metabolism, changes in lipid metabolism, expressed in a low level of cholesterol, total lipids, are the most constant and significant. X-ray changes in the bone tissue are the presence of general osteoporosis from moderate to severe, and bone deformation is possible. Bone age does not correspond to the passport age - the first always lags 0.5-2 years. In radiocontrast studies of the digestive tract, violations of the relief of the mucous membrane of the small intestine, the appearance and growth of fluid levels in the intestinal loops when a wheat flour or gliadin solution is introduced with a contrast substance, a motor function disorder of various parts of the small and large intestines, and enlargement of the large intestine in diameter.

Endoscopic changes in celiac disease are characterized as atrophic cervicalis( inflammation of the small intestine with a decrease in the number and size of intestinal villi taking direct part in the digestion of food), while the jejunum has a characteristic "pipe" due to lack of folds, motor activity, pale-grayish color mucous due to swelling, the presence of a thin layer of white coating( a sign of hoarfrost).It should be noted that more than half of the patients with celiac disease show concomitant( secondary) disaccharidase insufficiency. The appointment of the aglyadine diet contributes not only to the restoration of the structure of the small intestine mucosa, but also to the increase in the activity of digestive enzymes, which is not observed in cases of primary disaccharidase insufficiency.

Treatment of the disease

A gluten-free diet is prescribed to the child( bread, biscuits, cakes, cookies, pasta, sausages are excluded).From the drugs are prescribed vitamins and trace elements.

Exception from the diet of gluten leads to the disappearance of all symptoms of the disease, but the re-use of gluten again causes disruption of the structure of the mucosa of the small intestine. Therefore, the diagnosis of celiac disease should be confirmed by results of at least 3 biopsies, which is consistent with WHO recommendations.

The basis of celiac therapy is the agliadin diet, which requires the complete exclusion of food products made from wheat, rye, barley, oats, which can be replaced with products made of rice, corn, buckwheat, maize, soy. It should be borne in mind that starch containing traces of gluten can be a component of many foods and medicines. Therefore, with a strict diet, control is necessary and for the lack of starch in the composition of the capsules of tablets taken for therapy. Often, concomitant celiac disease, disaccharidase deficiency and reduced tolerance to fats also require appropriate dietary correction. Substantial moment in the treatment of celiac disease is substitutive and symptomatic therapy.

The prognosis for the timely conduct of adequate treatment and rehabilitation measures is generally favorable, the lethality from celiac disease is practically zero. In adults with celiac disease, the incidence of malignant neoplasms is somewhat higher than in healthy individuals.

Forecast

The prognosis of the disease is favorable when conducting adequate adequate therapy.

Prevention of the disease

There is no specific prevention of the disease, since the cause of its occurrence has not been established.