Celiac disease (or gluten intolerance) is a genetic disorder that affects at least one American among 133. 
The symptoms of celiac disease may range from the classics such as diarrhea , weight loss and malnutrition to symptoms such as isolated nutritional deficiencies but no symptoms gastrointestinal disorders.

In the case of celiac disease, if you eat gluten an immune response occurs in the small intestine.

Over time, this reaction produces inflammation that damages the inner wall of the intestine and prevents the absorption of some nutrients (malabsorption). 
When the immune system has an exaggerated reaction to gluten in food, the immune reaction damages the hair-like small villi (villi) lining the small intestine. 
The villi absorb vitamins, minerals and other nutrients from the food we eat. 
The villi usually look like a microscopic scale. 
The damage caused by celiac disease changes the inner surface of the small intestine that becomes like a smooth tile floor. 
Thus, the body loses the ability to absorb the nutrients needed for growth and good health.

Link to : Celiac Association of Brazil

Who gets sick with celiac disease?

It needs to be born with the genetic predisposition to celiac disease. The most important genes associated with gluten intolerance are HLA-DQ2 and HLA-DQ8. 
One or both of these genes are present in almost all people with celiac disease. While 30% of the population have one or both of these genes, 3% of these develop gluten intolerance. 
A first-degree relative (father, brother, son) of a person with celiac disease has about a 10% chance of getting sick. 
If one identical twin has celiac disease there is a 70% chance that the other twin will have this intolerance (but it is not necessarily diagnosed at the same time). 
Environmental factors play an important role in causing celiac disease, in childhood or later in life.


Causes and risk factors of celiac disease

untreated celiac can cause:

Celiac disease can affect anyone. However, it tends to be more common in people who have:

  • A family member with celiac disease or dermatitis herpetiformis
  • Type 1 diabetes ,
  • Down syndrome or Turner,
  • Autoimmune Thyroid Diseases
  • Sjögren Syndrome,
  • Microscopic colite (collagenous or lymphocytic colite)

Symptoms of celiac disease can be moderate to severe.

Symptoms in adults include:

The symptoms are often intermittent (they are attenuated and then start again), sometimes they appear independently of diet and digestive symptoms. 
Mild cases of celiac disease may be asymptomatic, so intolerance is often detected only during examination for another disease. 
However, treatment is recommended for the complications that can occur in these cases.


Severe celiac disease

Severe symptoms of celiac disease include:

  • Diarrhea that may occur suddenly overnight, resulting in incontinence (loss of bowel control)
  • Weight loss,
  • Stomach pain ,
  • Muscle spasms.

In some cases, headaches or chronic migraines. 
Feces may contain excessively high levels of fat (steatorrhea), which makes them soft, light in color and strong and unpleasant odor. 
It can make it difficult to remove stool from the toilet. 
If gluten intolerance is not cured, the consequence is that you can not digest food normally and malabsorption may occur. 
This causes fatigue  and lack of energy. 
Malnutrition in children can slow growth in terms of height and can delay puberty.


Symptoms of celiac disease in children

Celiac disease is often diagnosed in children who produce large amounts of smelly diarrhea, have abdominal bloating and pain. 
These children often appear malnourished (some are); although they are usually very thin, their stomach grows significantly because of the swelling. 
Instead of diarrhea, children may suffer from constipation due to celiac disease. Constipation due to gluten intolerance occurs with abdominal pain and abdominal distension; some children may have alternating constipation and diarrhea. 
Another typical symptom of celiac disease in children is the lack of growth, these children retard growth, weight gain and height is significantly lower than other cyanos with the same age.
If not diagnosed, these children may be of short stature in adulthood due to gluten intolerance. 
However, children with celiac disease are not always underweight. 
A recent study shows that almost one child out of five is overweight when the diagnosis was made, while 75% were normal weight.

Most children who were very heavy lost weight after starting to follow the gluten-free diet. 
Children with typical symptoms of celiac disease arrive at diagnosis earlier than those who exhibit less typical symptoms, probably because doctors recognize that they are more likely to have celiac disease. 
They also have more intestinal damage related to celiac disease compared to children with atypical symptoms. 
Atypical symptoms in children are: anemia , irritability and Attention Deficit Hyperactivity Disorder (ADHD). 
A small minority of children (about 30%) have iron-deficiency anemia as the main sign of celiac disease.
This anemia can affect children and adults with celiac disease because they can not absorb iron from the food they consume. 
It usually resolves quickly when it comes to diagnosis of gluten intolerance and begins the gluten-free diet. 
Many children with celiac disease without a diagnosis have a constant celiac irritability, although it is unclear why this happens. 
It is possible that it simply does not feel good or there may be a connection with a lack of vitamins, lack of essential fatty acids and vitamin B-12 that can affect the mood and function of nerves. 
Finally, a diagnosis of Attention Deficit Hyperactivity Disorder should suggest that a gluten intolerance test should be done.
More than 15% of people with ADHD may have celiac disease, but they follow a gluten-free diet that seems to relieve the symptoms of ADHD.


What is celiac disease, latent and silent?

Latent and silent are terms used to refer to individuals who have inherited the genes that predispose them to celiac disease but have not developed symptoms or signs of gluten intolerance. 
Latent celiac disease refers specifically to individuals with abnormal antibodies in blood tests for celiac disease, but the bowel has a normal wall and the patient has no signs or symptoms of celiac disease.

For example: 
Some individuals may have had an early gluten intolerance in childhood and the disease can be treated with a gluten-free diet. 
The patient’s bowel may have a normal appearance and functionality and there may be no signs or symptoms of celiac disease. 
Some individuals with celiac disease in childhood, abadonam the gluten-free diet as adults, but remain without signs or symptoms of intolerance. 
In both cases described above, celiac disease is latent and individuals may develop signs and symptoms later in life.
Silent celiac disease refers to individuals who have abnormal antibodies in blood tests for celiac disease and have lost villi in the small intestine, but have no symptoms or signs of celiac disease, even with a diet containing gluten. 
As individuals who have latent gluten intolerance, these people may develop signs or symptoms later in their lives.


Complications of celiac disease

Untreated celiac disease can cause: 
Malnutrition . One consequence of small bowel damage is the inability to absorb enough nutrients. 
Malnutrition can cause anemia and weight loss. 
In children, malnutrition can cause developmental delay. 
Loss of bone density
Malabsorption of calcium and vitamin D may lead to reduced bone density (osteomalacia or rickets) in children and osteoporosis in adults. 
Infertility and miscarriage . 
Malabsorption of calcium and vitamin D can cause reproductive problems.


Lactose intolerance

Bowel damage can cause abdominal pain and diarrhea after eating foods that contain lactose, although they do not contain gluten. 
When the intestines are cured, you may still be able to tolerate dairy products. 
However, some people continue to have lactose intolerance , even if they manage to keep celiac disease under control.

Celiacs that do not follow a gluten-free diet have a higher risk of developing various forms of cancer, includingintestinal lymphoma and small bowel cancer.

If gluten intolerance does not respond to gluten-free diet

More than 15 percent of people with celiac disease are unable to follow a gluten-free diet. 
The disease, known as malabsorption syndrome, is often due to contamination of the diet with gluten. 
A Mayo Clinic study concluded that people with this syndrome often have more illnesses such as bacterial intestinal contamination syndrome, colitis, poorly pancreatic disorders or irritable bowel syndrome .


Refractory celiac disease

In rare cases, the intestinal damage of celiac disease continues even if you follow a strict gluten-free diet. 
This disease is known as celiac disease refractory or non-responsive to diet. 
If signs and symptoms continue even on a gluten-free diet for six months or a year, your doctor may recommend additional tests to monitor intolerance and look for other explanations for the symptoms. 
Your doctor may recommend cortisone treatment to reduce intestinal inflammation or a drug that suppresses the immune system.


How is the diagnosis of celiac disease made?

Recognizing celiac disease can be difficult because the symptoms are similar to other diseases. 
Gluten intolerance can be confused with irritable bowel syndrome, colitis, diverticulitis , intestinal infection , chronic fatigue syndrome, and iron-deficiency anemia caused by loss of menstrual blood. 
As a result, celiac disease is often misdiagnosed. Since doctors have become more aware of the symptoms of the disease and have been introduced more reliable blood tests, the number of diagnosed cases is increasing.


Blood tests for celiac disease

People with celiac disease have the values ​​of some antibodies above normal in the blood, are the proteins that react against the cells of the body or tissues. 
To diagnose celiac disease, doctors prescribe blood tests for anti-transglutaminase antibodies (anti-tTG) or anti-endomysial ( IgA ) antibodies . 
If the test results are negative, but the disease is still suspected, further blood tests may be done. 
Before taking the tests, the patient should continue to follow a diet that includes foods with gluten, such as bread and pasta. 
If a person stops eating gluten foods before taking the test, the results may be negative for celiac disease, although the disease is present.


Intestinal biopsy for celiac disease

If blood tests and symptoms suggest celiac disease, a small bowel biopsy is performed to confirm the diagnosis. 
During a biopsy, the doctor removes small pieces of tissue from the bowel to see if the villi are present. 
To remove the tissue sample, the doctor inserts a long thin tube called the endoscope through the patient’s mouth and the stomach into the small intestine. The doctor collects the samples using instruments that pass through the endoscope.


Dermatite herpetiforme

A dermatite herpetiforme (DH) é uma erupção cutânea com bolhas que causam muita coceira e afetam 15-25 por cento das pessoas com doença celíaca. A erupção ocorre normalmente nos cotovelos, joelhos e nádegas.
A maioria das pessoas com DH não tem nenhum sintoma digestivo da doença celíaca.
Dermatite herpetiforme é diagnosticada através de exames de sangue e uma biópsia da pele.
Se o teste de anticorpos é positivo e a biópsia de pele mostra resultados típicos de dermatite herpetiforme, não é necessária uma biópsia intestinal do paciente. Tanto a doença da pele que a doença intestinal respondem a uma dieta livre de glúten e voltam a ocorrer se o glúten é adicionado à dieta.
Erupções cutâneas podem ser controladas com antibiotics such as dapsone. Because dapsone does not treat intestinal disease, people with dermatitis herpetiformis should maintain a gluten-free diet.


Screening for celiac disease means screening the presence of autoantibodies in the blood in people with no symptoms. 
Americans are not tested for celiac disease normally. 
However, since celiac disease is hereditary, family members of a person with the disease may ask to take the examination. 
Four to twelve percent of a celiac person’s first degree relatives have celiac disease.


When should children be tested for celiac disease?

Like adults, children can develop gluten intolerance at all times and therefore should do the exams when they feel the symptoms, even if such symptoms are subtle or atypical. 
In addition, children with celiac relatives can do analysis, even if they do not have any symptoms. 
It is quite common to find celiac disease asymptomatic or silent we relatives of coeliacs. 
These individuals should also adopt a gluten-free diet to avoid future complications of the disease. 
The diagnosis of celiac disease is performed with a series of blood tests for celiac disease looking for specific antibodies. 
If they are positive or indicate gluten intolerance, the next step is an endoscopy to see if the bowel is damaged.
If the child gets a diagnosis of celiac disease, the only treatment is a gluten-free diet. 
The good news is that the child may be growing after the diagnosis and can solve all problems of attention and irritability. 
Many parents see that after the diagnosis, the child is much happier, more energetic and has better results in school after starting the diet.

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