Gluten intolerance: a form of allergy that leads to celiac disease
Celiac disease is an intolerance to an almost ubiquitous protein: gluten, which causes digestive pain, diarrhea and weight loss. It is not a true allergy, but an autoimmune disease that extends beyond the intestine. Hypersensitivity to gluten, without true celiac disease, that is to say without autoimmune disease, is a syndrome that is growing.
Gluten intolerance is called celiac disease.
It is an autoimmune disease triggered by exposure of the digestive tract to a protein found in many food grains.
This repeated exposure to gluten is responsible for an inflammatory and immune reaction of the lining of the small intestine.
This inflammatory reaction results in a profound change in the appearance of the intestinal mucosa in histology. This mucous membrane, which normally has numerous villi in order to increase the absorption surface of the intestine, atrophies and the villi can go so far as to disappear.
The disease is accompanied by autoantibodies directed against gluten and its fractions.
If it is not very marked and appears in adulthood, we speak of gluten sensitivity.
When should you think about gluten intolerance?
A frequent disease, gluten intolerance can give rise to marked signs in children, but they are uncharacteristic in adults where it often goes unnoticed. This explains why it is diagnosed on average more than ten years after the appearance of the first signs.
In infants, the first symptoms occur a few weeks after the introduction of flour in milk, therefore gluten. This change triggers diarrhea that becomes "chronic" (it continues beyond 15 days), with abundant stools. The baby lacks appetite. He changes his behavior and becomes less active. Its weight can stagnate then decrease and its growth in size is sometimes disturbed.
In children, the symptoms of celiac disease can be very variable. There may be digestive disturbances, such as chronic or intermittent diarrhea, nausea and vomiting , and / or lack of appetite. Sometimes the child also has recurrent abdominal pain or bloating due to an accumulation of intestinal gas.
We can also observe non-digestive signs such as weight loss and / or growth retardation, chronic fatigue, iron deficiency anemia , delay in the onset of puberty with "primary amenorrhea" in girls (delay in the onset of the first period ”), canker soresrecurrent or "herpetiform dermatitis", that is, blisters on the skin grouped in itchy clumps.
In adults, we can also observe digestive signs such as chronic diarrhea, which is the most common symptom, but also constipation . Some adults suffer from abdominal pain or bloating, associated with flatulence and weight loss. The non-digestive signs are numerous. There may thus be chronic fatigue, anemia due to iron, vitamin B9 or folic acid deficiency, recurrent canker sores, herpetiformis dermatitis, fractures linked to osteoporosis , unexplained sterility, peripheral neuropathy (damage to the nerves of the members)…
Some children or adults immediately develop easily identifiable signs. Others, the elderly in particular, present less typical manifestations and it is only the late complications of gluten intolerance that will reveal the disease.
How to diagnose gluten intolerance?
The diagnosis of celiac disease is made using a combination of clinical, immunological and histological arguments. But it is always difficult to confirm, which is why it can take a long time before one thinks of this condition in the face of uncharacteristic digestive symptoms.
The most common manifestations are abdominal pain, chronic diarrhea, weight loss, bone problems, anemia and asthenia.
If celiac disease is suspected, the blood is tested for antibodies that are produced during the course of the disease: anti-reticulin, antigliadin, anti-endomysium and antitransglutaminase antibodies. According to a recent evaluation by the French National Authority for Health, only the search for anti-endomysium antibodies and anti-transglutaminase antibodies is contributing to the diagnosis of celiac disease.
If this antibody test is positive, it makes it possible to confirm the disease and to decide on a biopsy of the small intestine during an endoscopy.
Only biopsies (performed during an endoscopy) can really confirm the diagnosis. Most often performed in adults before setting up a gluten-free diet that will be lifelong, biopsies remain discussed in children because of the risk associated with general anesthesia during endoscopy. If the serological tests are negative, it is generally unnecessary to have biopsies of the small intestine. To clarify the diagnosis, the doctor may request genetic tests highlighting the HLA DQ2 and HLA DQ8 genes, often present in gluten intolerance. So when the symptoms of the disease are present, the specific antibodies are high and the HLA group is typical, it is possible to not ask for intestinal biopsies.
Gluten intolerance is called celiac disease.
It is an autoimmune disease triggered by exposure of the digestive tract to a protein found in many food grains.
This repeated exposure to gluten is responsible for an inflammatory and immune reaction of the lining of the small intestine.
This inflammatory reaction results in a profound change in the appearance of the intestinal mucosa in histology. This mucous membrane, which normally has numerous villi in order to increase the absorption surface of the intestine, atrophies and the villi can go so far as to disappear.
The disease is accompanied by autoantibodies directed against gluten and its fractions.
If it is not very marked and appears in adulthood, we speak of gluten sensitivity.
When should you think about gluten intolerance?
A frequent disease, gluten intolerance can give rise to marked signs in children, but they are uncharacteristic in adults where it often goes unnoticed. This explains why it is diagnosed on average more than ten years after the appearance of the first signs.
In infants, the first symptoms occur a few weeks after the introduction of flour in milk, therefore gluten. This change triggers diarrhea that becomes "chronic" (it continues beyond 15 days), with abundant stools. The baby lacks appetite. He changes his behavior and becomes less active. Its weight can stagnate then decrease and its growth in size is sometimes disturbed.
In children, the symptoms of celiac disease can be very variable. There may be digestive disturbances, such as chronic or intermittent diarrhea, nausea and vomiting , and / or lack of appetite. Sometimes the child also has recurrent abdominal pain or bloating due to an accumulation of intestinal gas.
We can also observe non-digestive signs such as weight loss and / or growth retardation, chronic fatigue, iron deficiency anemia , delay in the onset of puberty with "primary amenorrhea" in girls (delay in the onset of the first period ”), canker soresrecurrent or "herpetiform dermatitis", that is, blisters on the skin grouped in itchy clumps.
In adults, we can also observe digestive signs such as chronic diarrhea, which is the most common symptom, but also constipation . Some adults suffer from abdominal pain or bloating, associated with flatulence and weight loss. The non-digestive signs are numerous. There may thus be chronic fatigue, anemia due to iron, vitamin B9 or folic acid deficiency, recurrent canker sores, herpetiformis dermatitis, fractures linked to osteoporosis , unexplained sterility, peripheral neuropathy (damage to the nerves of the members)…
Some children or adults immediately develop easily identifiable signs. Others, the elderly in particular, present less typical manifestations and it is only the late complications of gluten intolerance that will reveal the disease.
How to diagnose gluten intolerance?
The diagnosis of celiac disease is made using a combination of clinical, immunological and histological arguments. But it is always difficult to confirm, which is why it can take a long time before one thinks of this condition in the face of uncharacteristic digestive symptoms.
The most common manifestations are abdominal pain, chronic diarrhea, weight loss, bone problems, anemia and asthenia.
If celiac disease is suspected, the blood is tested for antibodies that are produced during the course of the disease: anti-reticulin, antigliadin, anti-endomysium and antitransglutaminase antibodies. According to a recent evaluation by the French National Authority for Health, only the search for anti-endomysium antibodies and anti-transglutaminase antibodies is contributing to the diagnosis of celiac disease.
If this antibody test is positive, it makes it possible to confirm the disease and to decide on a biopsy of the small intestine during an endoscopy.
Only biopsies (performed during an endoscopy) can really confirm the diagnosis. Most often performed in adults before setting up a gluten-free diet that will be lifelong, biopsies remain discussed in children because of the risk associated with general anesthesia during endoscopy. If the serological tests are negative, it is generally unnecessary to have biopsies of the small intestine. To clarify the diagnosis, the doctor may request genetic tests highlighting the HLA DQ2 and HLA DQ8 genes, often present in gluten intolerance. So when the symptoms of the disease are present, the specific antibodies are high and the HLA group is typical, it is possible to not ask for intestinal biopsies.
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