Celiac disease

Celiac disease (Guy-Herter-Geibner disease, glutenenteropathy, intestinal infantilism), is characterized by impaired intestinal absorption, sub- or atrophy of the jejunum mucosa and an unconditionally positive reaction to the gluten-free diet (exclusion of cereal containing gluten from food). Celiacia occurs approximately at a frequency of 1: 3,000 and is inherited by an autosomal dominant type.

Etiology, pathogenesis. The relationship of the disease with the ingestion of gliadin, a protein of wheat, rye and oats, was established. However, the mechanism of the pathological interaction of gliadin with the mucosa is not fully understood. There is an assumption about the presence of an enzyme defect - the lack or insufficiency of gliadaminopeptidase or another enzyme involved in the splitting of gluten. There are reports of an immunological response (humoral and cellular) to gluten, occurring in the own layer of the mucosa of the small intestine.

Clinical picture. Among the clinical options should be allocated true celiac disease and celiac disease, which can develop in a variety of bowel diseases (developmental abnormalities, infections, prolonged use of antibiotics, etc.). The beginning of celiac disease often coincides with the introduction into the diet of a child of lures containing flour products. Therefore, children are more often ill at the age of 6-12 months. There is a rapid frothy stool, abundant, with a sharp odor, light or with a greyish tinge, greasy. In feces, as a rule, there is no pathogenic intestinal microflora. Treatment of dyspepsia with conventional means (antibiotics, enzyme preparations, reduction in nutrition, etc.) has no effect. The child becomes flaccid, pale, loses body weight, appetite decreases. Gradually develops dystrophy and children acquire a typical celiac disease: a sharp exhaustion, extinct eyes, bright mucous membranes, huge belly size. In a number of cases, edema develops on the lower limbs, spontaneous bone fractures are not uncommon. Pseudoacetis is determined (accumulation of fluid in the atonic intestine). Further, the symptoms of multivitamin deficiency (dry skin, stomatitis, dystrophy of the teeth, nails, hair, etc.) are added.

As a rule, with celiac disease, especially with prolonged flow, there is a disturbed absorption of disaccharides, fats, vitamins, iron, calcium, cystine transport, exchange of tryptophan, ie, universal malabsorption. In this regard, polymorphism of the clinical picture is understandable. Children suffer not only physically, but also mentally (lability of mood, isolation, increased excitability, negativism). An important sign of the disease with prolonged its course is short stature.

The course of celiac disease is undulating, often secondary infection, in some cases decisive fate of the patient.

Diagnosis of celiac disease, if you remember about this disease, is not difficult. The totality of the data of the anamnesis, the characteristic type of patient and stool are sufficient for setting the presumptive diagnosis of celiac disease. If the condition of the patient improves against the background of the gluten-free diet, and the error in the diet leads to the appearance of a stool characteristic of celiac disease, the diagnosis is almost unquestionable. Specification of the diagnosis is possible with a thorough coprological examination (the presence of a large number of fatty acids and soaps in the stool), a biochemical blood test (hypoproteinemia, hypoalbuminemia, a decrease in the concentration of cholesterol and lipids, hypocalcemia, hypophosphatemia, hypoxeridemia, etc.), an x-ray study (osteoporosis, Horizontal levels in the loops of intestines, dyskinesia of the intestine). The final diagnosis is established by a meta-analysis of biopsies of the jejunal mucosa.

Differential diagnosis is carried out with intestinal cystic fibrosis, disaccharidic insufficiency, abnormalities of the gastrointestinal tract.

Treatment of celiac disease is complex. The basis of treatment is the appointment for a long period (years) of the gluten-free diet (bread, crackers, cookies, pastry flour and pasta, pates, sausages are excluded). Children well tolerate potatoes, fruits, vegetables, corn and soy flour, vegetable fats, meat and fish, etc.

If the gluten-free diet is observed, the body weight of the patients begins to recover after 3 weeks. Histological changes in the intestine begin to disappear after 2-2,5 years.

Simultaneously with the appointment of the gluten-free diet, symptomatic therapy is carried out: vitamins, calcium preparations, iron, enzyme preparations, massage, gymnastics, etc. Children suffering from celiac disease should be on dispensary supervision.

The prognosis with respect to diet and proper treatment is favorable.