Celiac disease is an autoimmune disease whose symptoms appear as a result of eating foods that contain gluten. Celiac disease can cause complaints to the digestive system and can cause serious complications if left untreated.
Gluten is a type of protein that can be found in certain foods, such as bread, pasta, cereal and crackers. This protein functions to make bread or food dough elastic and supple.
Gluten is generally safe for consumption. However, in people with celiac disease, the immune system overreacts to gluten. This reaction will cause inflammation which over time can damage the lining of the small intestine and interfere with the absorption of nutrients.
Causes and Risk Factors for Celiac Disease
Celiac disease occurs when the body's immune system reacts abnormally to gliadin, a protein component found in gluten.
The patient's immune system perceives gliadin as a threat and produces antibodies to fight it. These antibodies cause inflammation in the intestine and interfere with the digestive process.
It is not yet known what causes this condition to occur. However, there are a number of factors that can increase a person's risk of developing celiac disease, namely:
- Have a family history of celiac disease or dermatitis herpetiformis
- Have type 1 diabetes , Addison's disease, Turner syndrome, Down syndrome, Sjogren 's syndrome , thyroid gland disease, epilepsy, or ulcerative colitis
- Have had a digestive system infection (such as a rotavirus infection ) as a child
In some cases, celiac disease can become active in patients who are pregnant, have recently given birth, are undergoing surgery, have a viral infection, or are experiencing severe emotional problems.
Symptoms of Celiac Disease
Symptoms of celiac disease can be different in children and adults. In children, symptoms include:
- Chronic diarrhea
- Nausea and vomiting
- Stomach ache
- The stool smells bad, is greasy, and looks pale
- Weight loss or difficulty gaining weight
Symptoms of celiac disease in adults can also include digestive disorders, such as diarrhea, nausea and vomiting, abdominal pain, and flatulence. However, most adults with celiac disease also experience symptoms outside the digestive system, such as:
- Joint pain
- Iron deficiency anemia
- Bone loss (osteoporosis)
- The body gets tired easily
- Damage to tooth enamel
- Irregular menstruation
- Tingling and numbness in the fingers and toes ( peripheral neuropathy )
- Miscarriage or difficulty getting offspring
Celiac disease can also cause dermatitis herpetiformis , which is characterized by complaints of a skin rash accompanied by blisters and itching. The rash generally appears on the elbows, knees, buttocks and scalp, but can also affect other parts of the body.
Although this condition also occurs as a result of the immune system's reaction to gluten, people with celiac disease who develop dermatitis herpetiformis generally don't experience complaints in the digestive system. It is estimated that 15–25% of people with celiac disease will experience dermatitis herpetiformis.
When to see a doctor
Immediately check with your doctor if you experience persistent diarrhea or digestive complaints that have lasted more than 2 weeks. Check with your pediatrician if your child has difficulty gaining weight, is pale, or has loose stools with rancid odors.
If you have a family with celiac disease or have other risk factors for celiac disease, discuss with your doctor whether you need to have a test to detect this disease.
Diagnosis of Celiac Disease
The doctor will ask about the symptoms experienced by the patient, and the medical history of the patient and his family. If the patient's symptoms and complaints point to celiac disease, the doctor will carry out supporting examinations, such as:
- Blood test, to detect antibodies associated with celiac disease
- Genetic tests, to rule out the possibility that the symptoms experienced by patients are caused by other diseases, by detecting genetic abnormalities in the HLA-DQ2 and HLA-DQ8 genes
It is important that the patient is not put on a gluten-free diet before the above tests are carried out. If during the test the patient is already on a gluten-free diet, the test results may appear normal even though the patient actually has celiac disease.
If the blood test results suggest that the patient has celiac disease, the doctor will carry out further tests to confirm the diagnosis. These checks include:
- Endoscopy , to see the condition of the small intestine using a small tube with a camera (endoscope) or endoscope capsule
- Biopsy, namely taking tissue samples in the skin (for patients experiencing symptoms of dermatitis herpetiformis) or tissue samples in the small intestine, to be examined in the laboratory
If celiac disease is discovered late or there are symptoms that lead to osteoporosis , the doctor may suggest a bone density examination to check whether the patient has impaired absorption of calcium and other nutrients that are important for bone strength.
Celiac Disease Treatment
The main way to deal with celiac disease is to avoid any foods or ingredients that contain gluten. Apart from food, gluten is also found in medicines, vitamins, and even lipstick. This method must be done for life to prevent complications.
With a gluten-free diet, patients will avoid damage to the intestinal wall and digestive-related symptoms, such as diarrhea and abdominal pain. Some natural gluten -free foods that can be consumed are:
- Milk and its derivative products
In addition to the types of food above, there are also types of gluten-free flour, such as rice flour, soy flour, sorghum flour , corn flour , and potato flour.
In pediatric patients, a gluten-free diet for 3–6 months may heal the damaged intestine. However, in adult patients, recovery may take up to several years.
In addition to a gluten-free diet, additional therapy may also be needed to manage symptoms and prevent complications. These therapies include:
In some cases, celiac disease can interfere with the work of the spleen, making the patient susceptible to infection. Therefore, patients need additional vaccinations to prevent infection, such as:
- Influenza vaccine
- Haemophillus influenza type B vaccine
- Meningitis C vaccine
- Pneumococcal Vaccine
Vitamin and mineral supplements
If the patient is considered to have anemia and severe malnutrition, or if the patient's diet cannot guarantee adequate nutrition, the doctor will provide supplements so that the patient gets all the nutrients the body needs. Supplements that can be given by doctors include:
- Folic acid
- Vitamin B12
- Vitamin D
- Vitamin K
Doctors will prescribe corticosteroids for patients whose intestines are severely damaged. In addition to controlling inflammation, corticosteroids are also useful for relieving symptoms during the intestinal healing process.
Dapsone is given to patients with celiac disease who experience symptoms of dermatitis herpetiformis. These drugs work to speed up the healing process, but it may take up to 2 years for the symptoms of dermatitis herpetiformis to be controlled.
Doctors generally give dapsone in small doses, to prevent side effects such as headaches and depression . The doctor will also advise the patient to have regular blood tests to check for possible side effects.
Celiac Disease Complications
If left untreated or sufferers continue to eat foods that contain gluten, celiac disease can cause the following complications:
- Malabsorption and malnutrition due to the body not being able to absorb nutrients properly
- Infertility and miscarriage, which can be caused by a lack of calcium and vitamin D
- Lactose intolerance , due to the body's lack of enzymes to digest lactose, which is the sugar usually found in dairy products, such as cheese
- Low birth weight babies, in pregnant women with uncontrolled celiac disease
- Cancer, especially colon cancer , intestinal lymphoma, and Hodgkin's lymphoma
- Nervous system disorders, such as peripheral neuropathy and decreased ability to think and solve problems
In children, untreated celiac disease can cause long-term food absorption problems. This can cause complications in the form of:
- Failure to thrive in infants
- Porous teeth
- Anemia , which can reduce activity and performance in learning
- Short posture
- Late puberty
- Disorders of the nervous system, such as learning difficulties, ADHD , and seizures
Celiac Disease Prevention
Celiac disease cannot be prevented. However, the appearance of symptoms can be prevented by avoiding foods that contain gluten, such as: