Treatment of celiac disease in adults. Celiac disease in profile and frontal view, or how to find a black cat in a dark room

Celiac disease is a genetic autoimmune pathology transmitted in an autosomal dominant manner. This is a very unpleasant disease that causes a lot of inconvenience; the process is manifested by damage to the small intestinal lint due to the interaction with food proteins.
A characteristic symptom in patients with celiac disease is congenital intolerance to proteins, which are found in many foods.

Grains and cereal crops, for example, oats, rye, wheat, are vitally dangerous.

Signs

Celiac disease can occur in a variety of people age categories. Distinctive features diseases are inflammatory processes in the mucous membrane small intestine.

Fats and carbohydrates are quite difficult to absorb. Often the disease develops in people who regularly consume grain crops.

Celiac disease is caused by a lack of enzymes that break down the peptide gluten. Malabsorption syndrome occurs, which may be varying degrees gravity.

Characteristic signs of this syndrome: flatulence, delay physical development, weight loss, diarrhea.

To detect celiac disease they use immunological method and biopsy small intestine. If the diagnosis is confirmed, the doctor prescribes a lifelong gluten-free diet.

Reasons

The disease has a mixed genesis: autoimmune, hereditary. During the development of the disease, a person develops an allergic or immune reaction to a specific protein, which leads to critical processes in the small intestinal mucosa.

Vitamins and minerals are poorly absorbed, resulting in a lack of micronutrients in the body. According to statistics, the majority of patients with celiac disease live in Italy, America, and Austria.

Perhaps celiac disease occurs due to a lack of an enzyme that takes part in the breakdown of gluten. Damage to the small intestine is inevitable.

As a result of damage caused by gliadin, absorption is impaired. useful substances. The disease is complemented by intestinal atrophy.

While the body reacts positively to a gluten-free diet.

Reasons and factors:

Hereditary predisposition;
Excessive consumption of grains that contain gluten;
Trigger mechanism;
Stress;
Viral or intestinal infections.

The main culprit of celiac disease is protein, which is part of grain crops.

The hereditary factor of the pathology can be explained by its prevalence in the family. In the blood of all infected people, one can detect the genes of the herpes virus, which is activated by the same gene.

The disease develops in case of deficiency of the following enzymes:

Pepsin.
Trypsin.
Chymotrypsin.

The disease can develop again with pathologies of the stomach and liver.

Symptoms

Classic signs of the disease are anemia, exhaustion, diarrhea. In young children, developmental delays and psychological disorders can be noticed.

Signs of celiac disease in an adult:

Fatty stool;
General weakness and rapid fatigue;
Aphthous stomatitis;
Periodic pain in the navel area;
Feeling of numbness in the legs;
Regular constipation;
Excessive irritability.

Disturbances in the gastrointestinal tract lead to lethargy, decreased appetite, and deterioration of metabolic processes.

As celiac disease develops, exhaustion, abdominal enlargement, swelling of the limbs, and bone fractures appear. Hair begins to fall out, nails become split, skin becomes dry due to a lack of vitamins.

People suffering from celiac disease often experience a feeling of depression, excessive irritability, and are in a bad mood.

Celiac disease in adults is an insidious disease that slowly destroys the cells of the small intestine that are responsible for digesting fats, carbohydrates and other microelements.

During celiac disease, you may notice the following symptoms:

Frequent diarrhea, approximately 5 times a day. The stool is profuse and progresses to constipation. Undigested fiber remains are present in the stool;
A terrible complication is a strong one intestinal bleeding;
The main symptom is rumbling in the stomach, flatulence;
Muscle weakness, rapid progressive weight loss.

Video

Diagnostic methods

The opportunity to recognize celiac disease at the initial stage appeared with the advent of the serological diagnostic method. The basis of this method is the detection of antibodies.

The following methods are considered effective for identifying celiac disease:

Analysis of biopsy samples of the intestinal mucosa.
Biochemical blood test.
X-ray of the intestines.
FGDS.

Medicine advises to conduct an examination of all persons for whom chronic constipation and problems with the absorption of valuable microelements have become constant companions.

Applies also laboratory method diagnostics

It is based on identifying:

antibodies to endomysium;
antibodies to reticulin;
antigliadin antibodies.

Diet and nutrition

In treatment, follow a special diet strictly.

Products containing gluten are completely contraindicated, so exclude from your daily diet:

Bread and flour;
Candies, cookies, cakes, sweets;
Pasta;
Semolina.

The diet strictly prohibits the consumption of foods:

Sausages, cheeses, sausages;
Chocolate, ice cream;
Fish, canned food;
Kvass, vodka, coffee, cocoa.

If a patient is lactose intolerant, he is strictly prohibited from consuming milk.

Sometimes with celiac disease, patients are accompanied by a feeling of hunger. It is advisable to eat a boiled chicken egg.

People with celiac disease can eat the following foods:

Lean meat and fish, premium sausages;
Berries, fresh fruits, vegetables;
Vegetable and butter oils, natural honey;
Products made from buckwheat or corn flour.

Take into account that even an impeccable diet cannot completely cure this disease. It is important to keep a normal healthy image life.

Drug treatment

Pharmacological drugs used to normalize metabolic processes. They are shown in case acute form celiac disease.

The following medications may be prescribed to a sick patient:

Folic acid;
Preparations containing calcium and iron;
Saline solutions;
Multivitamins.

Analyzes

To put accurate diagnosis celiac disease, you need to undergo a number of diagnostic examinations:

X-ray of the intestine with the mandatory use of contrast;
biopsy of the intestinal mucosa;
stool test for the presence of occult blood;
computed tomogram;
densitometry;
coprogram;
FGDS.

When receiving the results of a biochemical blood test, pay attention to the following indicators:

impaired glucose tolerance;
hypocholesterolemia;
reduced number of B and T lymphocytes;
high values of antibodies to IgG and IgA.

The specialist, after assessing all indicators and determining the severity of the development of celiac disease, should prescribe to the patient course treatment(the most important thing is to exclude gluten-containing foods from the list of foods consumed by the patient). I would like to note that if the patient did not consume gluten before the examination, then the indicators may be normal, and, accordingly, it will be impossible to identify pathology.

Help from folk remedies

Of course, the main treatment for this chronic disease adherence to a gluten-free diet is considered.

Eliminate the following foods completely from your diet:

wheat;
rye;
beans;
oats;
lentils:
peas;
bread and bakery products;
canned meat;
canned fish;
ice cream;
instant soups;
bouillon cubes and seasonings containing gluten;
beer and beer drinks;
vodka;
pickled canned foods.

Use the funds traditional medicine:

Herbal decoction. It is necessary to take in a ratio of 1:1 the lure, the elm-leaved fiddlehead, the bedstraw, the sourweed, the lungwort, and the long-leaved speedwell. Place the mixture in an enamel saucepan and pour boiling water so that the water is 5 centimeters above the grass. Place the vessel with the contents on water bath and leave for ½ hour at a boil. Remove the broth from the water bath and filter, squeeze out the herb remaining on the filter. You need to take the infusion 50 milliliters 3 to 5 times a day. You must first consult with your doctor about the possibility of using this recipe patient.
Can be used for treatment and a decoction of more famous herbs– these are wormwood and sage. Initially, a mixture of these herbs is prepared in a 3:1 ratio. Next, 1 tablespoon of the prepared mixture should be poured with 200 milliliters of boiling water, the vessel with the contents is sealed and left for 2 hours. After time, the infusion is filtered and taken 50 milliliters 4 times a day at regular intervals. You should not prepare the infusion in large portions at once, otherwise the effect will not be obtained. Every day you need to use only fresh decoction.

These two recipes are considered effective, but in any case, you must always remember that this disease is very serious, and before self-medicating, you need to get additional advice from a specialist. If the patient’s condition worsens while taking the prepared decoctions, then it is necessary to stop the treatment procedure.

Consequences and complications

The manifestation of this diagnosis in the adult population is most often associated with hormonal disorder and therefore the consequences of not treating it, possible complications very dangerous. According to available medical statistics, women are prone to the disease. They may have problems menstrual cycles, the risk of infertility.

Men suffer from it much less frequently, but if detected, it is necessary to begin treatment, otherwise it can provoke erectile dysfunction.

Regardless of the patient’s gender, this disease is always accompanied by the presence iron deficiency anemia.

The patient has late stages possible development next row complications:

deficiency of certain groups of vitamins and microelements, they are administered by injection;
development of ulcerative conditions of the small intestine;
refractory celiac disease;
tumors;
development of osteoporosis.

Prevention

The disease, whatever it may be, is still better to prevent.

In the case of celiac disease, you should very carefully monitor your own body and the changes occurring in it.

If a person is at risk for a number of existing diseases (type 1 diabetes mellitus, irritable bowel syndrome, Down syndrome, chronic active hepatitis, lymphocytic colitis), then it is necessary to carry out full examination. First of all, hand over biochemical analysis blood.
Subject to availability hereditary predisposition You should start monitoring your diet as early as possible. Do not overuse products that contain gluten. Completely abstain from alcoholic and weak alcoholic drinks(vodka and beer).
At the time of family planning, get advice from a geneticist about the possibility of your future children acquiring this disease.
When a person knows the exact diagnosis, in order to prevent its development, one should constantly adhere to the rules the strictest diet. Since any entry of gluten into the body of a person suffering from this disease can trigger a relapse of the disease.
The use of traditional medicine recipes for preventive purposes is not prohibited, but only with the permission of a gastroenterologist. In some cases, not only an allergic reaction can be triggered, but also even greater intestinal irritation.

When the first signs of celiac disease appear, you should not delay your visit to a specialist, much less be afraid of examinations. There is an expression that “you need to know the enemy by sight.” Following all the rules of treatment, the disease recedes after 3-6 months, but preventive measures you will have to abide by for the rest of your life.

Celiac disease in adults

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Celiac disease is genetic disease, which is caused by the body’s inability to completely break down the gluten protein of cereals (gluten intolerance). The disease code according to ICD 10 is K90.0. Flaw digestive enzyme, which is responsible for this process, causes damage to mucous tissues thin section intestines and so-called poisoning by toxic metabolic products. Gliadin (wheat protein) intolerance is a permanent process that the patient will have to fight throughout life.

If a patient is diagnosed with celiac disease, the medical history begins at the time of formation digestive system baby in the womb. Celiac disease occurs in children and adults when they include foods containing a protein called gluten in their diet.

It can be found in foods such as cereal, pasta, bread, cookies or crackers. When this substance enters the body, the immune system begins to attack it, damaging the intestinal walls. This becomes an obstacle to normal, natural absorption nutrients, which are vital for maintaining health.

The pathogenesis of the disease is currently under investigation. In medical practice, the following reasons for the development of celiac disease are known:

Genetic predisposition. If a child in his family has relatives with this diagnosis, then there is a high probability that he will also be diagnosed with celiac disease. Sick parents increase the risk of transmitting the disease to their children tenfold. That's why timely diagnosis adults will help avoid the spread of celiac disease.
Down syndrome. Similar genetic abnormalities accompanied by heart defects and developmental disorders of many other organs (for example, intestines, stomach). The likelihood of developing celiac disease increases.
V chronic phase. If the disease is active for more than 6 months, then the patient’s liver is in an inflamed state all this time.
lymphocytic type. This is an acute inflammatory process in the colon, in which large number specific immune cells - lymphocytes.
Autoimmune pathologies. They are caused by an abnormal attack of the body's own immune cells. Most often, intestinal epithelial cells are affected, which contributes to sharp decline protective properties and increased susceptibility to the gliadin component.
Diabetes mellitus (type I). The diagnosis of celiac disease is often made in patients with damage to the pancreas who have elevated blood sugar levels.

Symptoms

The symptoms of celiac disease differ depending on the form of the disease that the patient has. Typical shape found in a large percentage patients.

All its signs are related to the functioning of the gastrointestinal system:

frequent stools with liquid discharge.
in the stomach.
the presence of mucus fragments in the stool.
significant reduction in human weight.
intolerance to dairy products, which is accompanied by diarrhea and pain in the stomach area.

Atypical celiac disease in children and adults has a mild clinical picture and occurs with a predominance of symptoms associated with other organs and systems human body. Manifests itself with the following symptoms:

depression, fatigue, anxiety;
decline physical activity, pallor of the epidermis, which are caused by low hemoglobin levels;
pain in the bone apparatus, joints;
frequent;
in the intestines;
inflammation and damage to mucous membranes oral cavity;
of different nature.

The latent form of the disease is very dangerous, as it occurs without visible symptoms, and the patient may not be aware of his diagnosis. Celiac disease syndrome in this case is expressed in the form of periodic bloating and liquid stool.

The disease in some cases can take a latent form. With it, celiac disease can only be detected through laboratory research. Typical symptoms may be completely absent.

Refractory type of celiac disease occurs with the following symptoms:

the presence of liquid stool with mucus inclusions.
reduction in body weight.
positive laboratory test results.
deterioration of health if a diet of gluten-free products is not followed.

Diagnostics

Testing for celiac disease includes a whole series clinical trials . The choice of one method or another depends on the symptoms of the disease, the age of the patient and general condition health.

Compiling a clinical history. The doctor will interview the patient about existing symptoms and complaints and find out the time of their occurrence. It is also necessary to indicate whether the patient has relatives with a similar diagnosis in his family. At the appointment, the patient must tell about all chronic or current diseases that he has.
Examination with palpation. During this manipulation, the specialist will palpate the abdomen to determine the feeling of pain and measure its circumference.
For celiac disease there are general and biochemical tests. In the first case, the clinical laboratory examines the blood material for the content important components: hemoglobin indicator, red blood cells, leukocytes, platelets. Deviation from the norm may indicate an inflammatory process in the body. A biochemical study can diagnose some forms of celiac disease by the presence of certain immunoglobulins. But the informative value of such a study will be noted only during the period of disease activity. Antibodies in celiac disease in children can be detected using a blood sample.
. Examination of stool for the presence of undigested food elements, fatty inclusions or dietary fiber. Additional research It is considered to check the stool for the presence of blood (detection signals inflammation of the intestinal tissue).
Examination of the digestive system using an endoscope with sampling of material for a biopsy of the small intestine. The collected material will then be sent for histological analysis.
. Using this diagnostic method, you can find abnormal processes in the digestive organs and damage to the walls of the small intestine.
Consulting other specialists can often help identify celiac disease. For example, a nutritionist, proctologist or therapist.

Treatment

Therapy of this disease is a complex of measures: treatment with medications and a specialized diet.

The basic rule for a person with this diagnosis is lifelong adherence to a gluten-free diet. So that the disease does not enter into acute stage, the effect of the damaging factor on the body should be excluded. After the regulation of eating behavior, the symptoms of the disease subside, and intestinal activity returns to normal.

Features of the diet are as follows:

Absolute exclusion from the diet of foods and dishes based on almost all grains (oats, barley, wheat, rye). Prohibited products also include flour-based products: bread, pasta, cookies and crackers, and cakes.
Gluten is a “hidden” component of many foods that should also not be in the patient’s diet. These include sausages, canned food, sausages, mayonnaise and other sauces, chocolate, cocoa, coffee.
Food should be “soft” and not irritate the walls digestive organs. Avoid spices, large amounts of salt, marinades.
Alcohol should only be consumed in extremely small quantities. Beer is strictly prohibited as it contains gluten.
The menu may include potatoes, dishes made from soy, rice and corn flour, fish, fruits, and lean meats.

The diet for children is also based on the above rules. Currently medical institutions offer products designed specifically for celiac disease patients.

Treatment of celiac disease in adults is accompanied by the use of hormonal drugs (prednisolone). Duration of the course – 6-8 weeks. TO similar treatment resorted to if an inflammatory process is diagnosed in the body, and the diet does not have a positive effect.

The doctor will recommend treating celiac disease together with eliminating vitamin deficiency. Only a specialist should select the appropriate multivitamin complexes. B vitamins are prescribed to normalize hemoglobin levels. If the course of the disease is marked by a decrease in bone density, then the patient is prescribed vitamin D and calcium-based medications.

Local treatment is also aimed at eliminating the accompanying symptoms of celiac disease. For prolonged diarrhea, take antidiarrheals. If there is severe exhaustion body and weight loss, patients are prescribed intravenous delivery of nutrients. During the inflammatory process, a person may develop a fever. In this case, antipyretic drugs will help.

Consequences of the disease

Timely treatment of the disease and adherence to diet is the key to a prosperous life for patients with celiac disease. If the established diet is violated, complications may arise:

tumors (mainly of the small intestine, esophagus, stomach);
the occurrence of ulcers on the surface of the intestine;
development ;
refinement bone tissue, frequent fractures;
acute vitamin deficiency (hypovitaminosis).

Therefore, when you notice the first symptoms, it is important to immediately contact a specialist who will prescribe effective treatment, will outline a gluten-free diet.

Celiac disease - chronic inflammation small intestine, the cause of which is hereditary intolerance to the protein gliadin, which is part of cereals. At the same time, a connection was established with the autoimmune nature of the disease.

The disease affects people different ages. Celiac disease in adults occurs more often in women at 30–40 years of age, in men at 40–50 years of age. There may be a latent course of the disease in childhood. It is known that women get sick 4 times more often.

The provoking factor for the manifestation of symptoms may be viral infection, chronic diseases digestive tract accompanied by a lack of enzymes.

Progression of the disease depends on adherence to a strict diet that excludes gliadin.

Intestinal symptoms

Intestinal damage is expressed in frequent stool. Celiac disease leads to the destruction of the cells of the small intestine, which are involved in the digestion of proteins, fats and carbohydrates to the degree of breakdown necessary for absorption into the blood. Diarrhea is caused by increased intestinal motility in response to undigested food debris.

The patient experiences diarrhea 5–6 times a day. The stool is profuse, alternating with constipation. Laboratory analysis sets increased content fatty inclusions and undigested fibers in stool.
With a pronounced atrophic process, ulceration of the intestine is possible, then there will be symptoms of blood in the stool.
Severe intestinal bleeding is considered a complication of celiac disease if the diet is not followed. It is caused by penetration of a small intestinal ulcer with rupture of the vessel.
A mandatory symptom is bloating and rumbling. Flatulence is also associated with impaired digestion.
Pain in the abdomen around the navel is cramping in nature in the form of intestinal colic, are associated with impaired intestinal innervation and spastic contractions.
Nausea and vomiting appear as a symptom of the body’s reaction to “foreign” cells of the intestinal mucosa.
Increased fluid loss with diarrhea causes dry skin and mucous membranes, peeling, and the appearance of premature wrinkles.
Patients note progressive weight loss and muscle weakness.

It has been established that the use of a diet without gliadin helps restore normal intestinal digestion in 85% of patients.

Symptoms of vitamin and hormone deficiency

Vitamins, hormones, enzymes that provide everything metabolic processes in the body, are synthesized only with the participation of protein and mineral complexes coming from food. The cessation of this process leads to symptoms of deficiency.

Lack of B vitamins causes increased fatigue, drowsiness, muscle weakness.
The lack of vitamin D in an adult body in conditions of a formed skeleton contributes to the leaching of calcium salts from bone tissue, and osteoporosis develops. The result is frequent fractures.
A low concentration of iron in the blood leads to iron deficiency anemia (anemia); the synthesis of red blood cells and their ability to capture oxygen molecules are hampered. Added to clinical symptoms oxygen starvation all organs.
Absence required quantity Vitamin E disrupts the synthesis of sex hormones, which is expressed in women by symptoms of amenorrhea, in men it leads to a decrease in potency. Sometimes celiac disease is discovered when a couple is being examined for infertility.
A disease not compensated by diet leads to the threat of miscarriage in a pregnant woman. A child born to a mother with celiac disease will have low weight, developmental defects are possible.

Autoimmune manifestations

The involvement of the autoimmune mechanism has been proven by the influence of the gene of the same name on the breakdown of gliadin and other autoimmune disorders.

Elderly patients with celiac disease experience joint pain, swelling, and stiffness during movement, which is associated with autoimmune polyarthritis.

Along with celiac disease, the patient may have type 1 diabetes mellitus, autoimmune thyroiditis(inflammation thyroid gland), hepatitis, systemic lupus erythematosus, baldness.

Genetic mutations in celiac disease establish links with others hereditary diseases, for example, Down syndrome. Celiac disease is much more common in adult patients with Down syndrome than in healthy people.

Symptoms of complications

Complications in the absence of a diet can be very serious and lead to death.

Perforation of an ulcer of the small intestine is manifested by acute pain around the navel. Intestinal contents entering abdominal cavity leads to state of shock and peritonitis. The temperature is rising. The stomach becomes board-shaped. The patient needs urgent surgical intervention.

Symptoms of bleeding also accompany the destruction of the small intestine. Possible bleeding varying degrees: from symptoms of blood in the stool to heavy internal blood loss with a fall blood pressure, pale skin, sticky sweat.

Celiac disease in adults is a risk factor for small intestinal cancer. Clinical manifestations will depend on the type of tumor, the direction of its growth, and the rate of growth.

Laboratory manifestations

Celiac disease is characterized by nonspecific and specific laboratory symptoms which help in diagnosis.

Specific symptoms are a positive reaction for the presence of antibodies to gliadin. Reliability of the analysis in the formulation correct diagnosis approximately 100%.

The disease in an adult is controlled by following a diet excluding gliadin-containing products. Compensation with vitamin and mineral supplements is regularly required. Patients should undergo regular examination and dispensary treatment from a gastroenterologist.

Celiac disease is a genetically determined disease accompanied by damage to the mucous membrane of the gastric tract and other pathological reactions that develop in response to the ingestion of peptides from a number of cereals (in particular, wheat, rye, oats and barley).

For the first time similar violation was described about 2000 years ago. But it was only at the end of the 19th century that the leading role of wheat in the development of “flour disease” was proven—that’s what celiac disease was called in those days.

Currently, this term refers to chronic, genetically determined autoimmune pathology gastrointestinal tract associated with impaired T-cell activity. Symptoms and pathogenetic changes are caused by intolerance to the grain endosperm (it is from it that flour is obtained during processing) of some cereal crops.

Previously it was believed that such enteropathy manifests itself only in early age. But recently they found out that celiac disease can for a long time occur latently and manifest in adults under the influence of certain provoking factors. The clinical picture of the disease is variable and is associated not only with symptoms of atrophic damage to the intestinal mucosa, but also with disorders of the immune response.

Doctors consider celiac disease to be a multifactorial pathology. There is no doubt that gluten intolerance is genetically predetermined, but against this background, lifestyle, nutrition, bad habits, etc. play an equally important role. Moreover, they are individual for each patient. Therefore, the symptoms of the disease depend on the combination of these factors.

As a rule, the disease occurs with alternating periods of remission, when the main symptoms of celiac disease subside, and the condition of the mucous membrane duodenum and the small intestine is normalized. In case of non-compliance with the diet and under the influence of some other reasons, a period of weakening clinical manifestations is replaced by an exacerbation.

The role of so-called environmental factors in the development of celiac disease is currently being actively discussed. The impetus for clinical trials was the increase in the number of patients in the 80s in Sweden, and only by the 90s the incidence decreased to normal indicators. Doctors suggested that this is due to the early introduction of complementary foods (at 4 - 5 months) based on gluten-containing products.

Besides hereditary factor, the risk of developing pathology in infants is determined by:

intrauterine fetal hypotrophy;
woman smoking during pregnancy;
previous intestinal infections;
rota-, entero- and adenovirus diseases suffered in the first months of life;
an increase in the level of pathogenic gram-negative flora in the intestine.

In adulthood, the manifestation of celiac disease can be triggered by:

stress;
changes in hormone levels during puberty and pregnancy;
bad habits;
intestinal infections;
pathologies of the digestive system.

The pathogenesis of celiac disease is predominantly due to the binding of gluten peptides to HLA-DQ2/DQ-8 molecules, which subsequently interact with specific immune cells CD4+ T lymphocytes. As a result, the mucous membrane of the small intestine develops inflammatory reaction. But first, gluten molecules are “processed” by the enzyme type 2 transglutaminase, which increases the degree of their binding to immunocompetent cells.

Under the influence of CD4+ cells, the main inflammatory mediators (interleukins, tumor necrosis factors, etc.) are produced, which cause damage epithelial cells intestinal mucosa. The antibodies formed as a result of this process are found not only in the digestive tract, but also in the liver, brain, lymph nodes, kidneys, skin. This causes the variability of the clinical picture of celiac disease.

Disorders of the digestion process are accompanied by changes normal microflora intestines. The metabolism of fatty and bile acids, cholesterol, breakdown and absorption of other food components. The production and absorption of vitamin K and group B decreases. The concentration of toxins that enter as a result of the development of pathogenic bacterial and viral microflora increases in the bloodstream.

Signs of celiac disease and modern diagnostic methods

Depending on the severity of clinical manifestations, several forms of celiac disease are distinguished:

atypical, prevail extraintestinal symptoms, signs of damage to the gastrointestinal tract are mild or absent;
latent(asymptomatic or hidden), the pathology does not make itself felt for a long time and usually manifests itself in adults under the influence of provoking factors; before the symptoms appear, the disease can only be recognized using specific diagnostic tests;
torpid(it is also called refractory), characterized by a lack of results from standard therapy and diet, the patient’s condition is improved only by treatment with corticosteroids, and symptoms from the gastrointestinal tract are pronounced.

There is also a description of a potential form of celiac disease in the literature. The patient has all laboratory signs diseases, however external manifestations are missing. In this form, the pathology can occur for many years and not appear until the end of life.

Signs of celiac disease can be divided into gastrointestinal and extraintestinal. The first group includes:

. The volume of stool increases, and massive accumulations of fat (steatorrhea) are found in the feces. Diarrhea is usually preceded by bloating, flatulence, loss of appetite, and attacks of nausea, sometimes ending in vomiting. Strong pain syndrome not typical, but some patients experience aching, dull, diffuse pain.
Constipation syndrome. Often found in adults. Feces contain undigested food debris. After visiting the toilet, there is a feeling that the intestines have not completely emptied.
Syndrome intestinal obstruction . Caused by severe disturbance of intestinal motility up to complete atony smooth muscle intestines.
Damage to other parts of the digestive tract. Often, patients with celiac disease experience inflammation of the oral mucosa (periodontal disease, gingivitis, stomatitis). Often diagnosed peptic ulcer associated with infection Helicobacter bacteria, gastritis, reflux. A violation of the secretory activity of the pancreas is also noted. Sometimes similar disorders affect insulin production.
Hepatobiliary pathology syndrome. Sometimes liver and gallbladder damage does not cause symptoms other than changes biochemical parameters blood. A more detailed study reveals an increase in liver size, an increase total bilirubin, fatty degeneration liver. In severe cases - primary biliary cirrhosis. The relationship between celiac disease and autoimmune hepatitis has also been proven.

Extraintestinal clinical signs hereditary celiac disease include:

Epidermal lesions. These are dermatoses of various etiologies, atopic neurodermatitis, acne. Sometimes patients complain of baldness. Skin rashes are often symmetrical in nature, accompanied by severe itching and burning. They are usually localized on the inner thighs, arms, buttocks and back.
Pathologies endocrine system . As a rule, there is a disturbance in the activity of the thyroid gland caused by autoimmune inflammation. In addition, women often cannot bear a child normally, pregnancy sometimes ends in spontaneous miscarriage, and representatives of the stronger sex are often diagnosed with male infertility associated with celiac disease.
Pathologies of the musculoskeletal system. Have severe consequences at an early age. Celiac disease can cause joint deformation, spontaneous fractures even with minor injuries, and tooth decay. This is associated with impaired absorption and metabolism of vitamin D.

Against the background of damage to the immune system, they develop allergic reactions, intolerance to a number of foods, bronchial asthma. Neurological disorders are also sometimes expressed, which are manifested by tremor, visual and speech disturbances (especially in early childhood).

As a result of damage to the intestinal mucosa, the absorption of fat-soluble vitamins is impaired. There is also a lack of vitamins C, P and K. Such disorders manifest themselves in the form of:

dryness, peeling, sagging skin;
general weakness;
decreased performance, physical endurance;
frequent gingivitis;
subcutaneous hemorrhages.

Diagnosis of celiac disease is carried out on the basis of medical history (the health status of close relatives is taken into account) and the results of laboratory and instrumental examinations.

Mandatory studies include:

Some patients are additionally prescribed:

specific tests for antibodies to gliadin;
Ultrasound of the thyroid gland, screening for hormones;
measuring the pH level in the stomach cavity;
tests for the content of vitamins and minerals;
determination of bone tissue density;
colonoscopy with biopsy of the rectal mucosa;
tomography;
MRI of the intestine with contrast.

Further consultations with specialists are indicated based on the results of the initial examination and research data. Some patients are referred to an endocrinologist, dentist, neurologist and other doctors.

How to treat celiac disease: drug therapy, nutritional habits, alternative methods and preventive measures

There is no specific treatment for celiac disease. That's why the only way If you don’t get rid of it, then at least alleviate the symptoms of the pathology by following a strict diet with the complete exclusion of gluten components.

Drug therapy is carried out to relieve associated symptoms and treat secondary acquired complications. So, they prescribe:

secretagogues gastric juice and normalization of pH levels from the group of inhibitors proton pump and H2-histamine receptor blockers;
enzyme preparations;
enterosorbents;
hepatoprotectors;
drugs that stimulate the secretion of bile and the dissolution of stones in gallbladder;
probiotics.

In case of stool disorders, anti-inflammatory and antimicrobial medications, products containing bismuth compounds, and adsorbents are prescribed. Some types of celiac disease (refractory), in addition to choosing a diet, require the mandatory use of corticosteroids. Budesonide is prescribed for daily dosage 9 mg for 4 to 8 weeks, then this amount is gradually reduced to 6 mg, and then to 3 mg.

Very important replacement therapy, since a long-term gluten-free diet leads to a deficiency of dietary fiber and vitamin deficiency. Therefore they use:

vitamins;
macro- and microelements;
preparations based on ferrous iron;
calcium.

In case of severe disturbances in blood flow and metabolic processes, nootropics are included in the scheme for treating congenital celiac disease.

Features of a gluten-free diet for patients with celiac disease

The list of permitted products includes:

buckwheat;
corn;
millet;
meat;
fish;
eggs;
milk;
vegetables;
potato;
fruits;
berries;
nuts;
legumes;
marmalade;
gelatin-based jelly.

wheat, rye bread;
bran;
confectionery, cooked with flour;
semolina;
pasta;
oatmeal;
pearl barley;
barley groats;
wheat cereal;
cutlets and other breaded dishes;
dumplings, dumplings and other dishes that contain flour in the recipe.

Some products contain so-called “hidden” gluten, and some unscrupulous manufacturers do not disclose this. Therefore, you should also exclude from your diet:

sausages;
ready-made semi-finished products;
canned food;
ready-made sauces, ketchup, tomato paste;
dry soups, jelly;
bouillon cubes;
imitation seafood (for example, crab sticks, etc.);
multi-component dry seasonings (Mivina, etc.);
cheeses, curd cheeses;
ready-made yoghurts;
ice cream;
instant coffee, cocoa, chocolate;
caramel.

A number of food additives, marked:

E 160b (annatto dye);
E 150a - d (caramel dyes);
E 411 (oat gum);
E 636 (maltol);
E 953 (isomaltol);
E 637 (ethyl maltol);
E 965 (malititol and maltitol syrup);
E 471 (glycerides of fatty acids).

Contrary to popular belief, alcoholic beverages are allowed. Everything is allowed in small quantities except kvass, beer, gin, whiskey and vodka (and cocktails based on them).

Strict adherence to a gluten-free diet leads to improvement in almost 90% of cases. But the structure of the intestinal mucosa is restored within six months. In the future, the patient is also recommended to select an appropriate diet. If there is no deterioration, you should visit a doctor and undergo a full examination once every 12 months.

Cure celiac disease folk remedies impossible. Healers recommend drinking decoctions of chamomile, calendula, milk thistle, caraway, thyme and other herbs that have an anti-inflammatory effect and normalize the microflora and enzymatic activity of the digestive tract.

Fedor 01/08/2019 3:24:37

I was in Diamondova, my blood pressure rose sharply, nothing was found, my blood pressure was lowered and I was discharged. Now I'm on sick leave again. and I have a constant headache and tinnitus. everything matches your characteristics.

Celiac disease (gluten enteropathy) is a disease of the small intestine, manifested by atrophy of the mucous membrane in response to the introduction of gluten. The prevalence of celiac disease varies significantly among different geographic areas. The disease occurs with the highest frequency in European countries (1-3:1000), with a lower frequency in African countries. It is believed that at least 1% of the world's population suffers from this disease. Celiac enteropathy is more often reported among women.

Damage to the small intestine in celiac disease occurs under the influence of gluten, a protein contained in cereal crops. Gluten consists of several components: prolamin, glutenin, albumin, globulin. It is prolamine that has a damaging effect on the intestinal mucosa. Its amount in different cereals is not the same. So, millet, rye, and wheat contain this protein in large quantities. Prolamine is found in smaller quantities in barley, oats, and corn. Prolamin is heterogeneous in its structure; wheat prolamin is called gliadin, barley prolamin is called hordein, and oat prolamin is called avein.

The key factor in the development of the disease is genetic predisposition. In people with this feature, when gluten comes into contact with the intestinal villi, specific antibodies are produced. This is how autoimmune inflammation of the intestinal tissue develops, leading to gradual atrophy of the organ mucosa.

Villous atrophy that develops in celiac disease, dystrophic changes enterocytes lead to a decrease in the absorption surface of the small intestine. As a result, the absorption of proteins, fats, carbohydrates, vitamins, and minerals is impaired. These changes lead to the appearance of characteristic clinical symptoms. Celiac disease can occur in three forms: classical, atypical, latent.

Gluten enteropathy occurs mainly in childhood. Children are stunted, muscle weakness, apathy, increased abdominal size, steatorrhea, and cramping abdominal pain are noted. Kids are emotionally labile and get tired quickly. But in some patients, the disease does not appear in childhood, but already in adulthood.

In general, the following symptoms are characteristic of classical celiac disease:

Loss of body weight (from 5 to 30 kg);
Decreased appetite;
Weakness, fatigue;
Stomach ache;
Dyspeptic symptoms: flatulence, nausea, ;
Edema;
Glossitis, ;
Iron deficiency;
Hypocalcemia with osteoporosis;
Hypovitaminosis.

Most constant symptom Celiac disease is recurring diarrhea, its frequency can reach ten or more times per day. The stool is mushy, light, liquid, foamy.

Constant, severe abdominal pain is not typical for celiac disease. However, people with celiac disease may experience cramping abdominal pain before or after bowel movements. And with flatulence, dull diffuse pain occurs.

When examining a person with celiac disease, attention is drawn to an enlarged abdomen.

Symptoms of atypical celiac disease

In most cases, celiac disease has an atypical course. In the clinical picture of the disease, gastroenterological symptoms may be absent or mild. Extraintestinal symptoms come to the fore:

Anemia;
Ulcerative stomatitis;
, frequent fractures;
Dermatitis herpetiformis (characterized by the appearance of itchy papulovesicular rashes on the elbows and buttocks);
Hemorrhagic syndrome;
Associates autoimmune diseases(autoimmune thyroiditis, diabetes mellitus, Addison's disease);
Defeat nervous system(, ataxia, epilepsy, polyneuropathy);
Deterioration of potency, menstruation disorders,.

If celiac disease is left untreated, complications of the disease can occur. The most common complications include:

Malignancy;
Chronic non-granulomatous ulcerative jejunoileitis and colitis;
Neuropathy.

In patients with celiac disease, it develops much more often than in the general population. In addition, cancer of the esophagus, stomach, and rectum is also more common. Unreasonable deterioration of the patient's condition, as well as laboratory parameters, despite adherence to a gluten-free diet, should prompt the thought of probable development malignant process.

Chronic non-granulomatous ulcerative jejunoileitis and colitis is characterized by the appearance of ulcerative defects on the mucous membrane of the jejunum, ileum, and colon. Ulcers may bleed or perforate.

Neuropathy manifests itself as numbness, tingling, weakness in the lower limbs. Defeat nerve fibers upper limbs observed less frequently. When the cranial nerves are damaged, diplopia, dysphonia, and dysarthria are observed.

Diagnostics

The symptoms of celiac disease are so varied and non-specific that certain tests should be carried out to confirm the suspected diagnosis. Since the key factor in the occurrence of celiac enteropathy is genetic predisposition, it is necessary to determine the family history of gluten intolerance.

The main diagnostic method is serological. In patients with gluten enteropathy, specific antibodies are detected in the blood:

Antigliadin (AGA IgG, IgM);
Endomysial (EMA IgA);
Antibodies to tissue transglutaminase (tTG).

No less important diagnostic method is a morphological study of the small intestinal mucosa. During endoscopy and histological examination intestinal tissue, signs of atrophic damage to the mucous membrane are determined with shortening of the villi, lengthening of the intestinal crypts.

Additional research methods:

- anemia is determined;
- hypoproteinemia, hypocalcemia, hypokalemia, hypomagnesemia are determined;
Scatological examination - a large amount of fat and soap is determined.

Treatment

Celiac disease is a disease that can be corrected through diet. When following a diet, the mucous membrane of the small intestine is restored and soon the person ceases to be bothered unpleasant symptoms diseases.

Principles of diet for celiac disease:

Excluding gluten-containing foods from the diet (bread, pasta and confectionery);
Mechanical and thermal sparing of the digestive tract (meals are steamed or boiled, consumed pureed or without chopping);
Elimination of foods that enhance fermentation (milk, legumes);
Limiting foods that stimulate the secretion of the pancreas and stomach (rich meat broths, fatty meat).

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In case of exacerbation of the disease, in addition to a gluten-free diet, drug treatment in order to eliminate metabolic disorders. Use the following groups drugs: