Celiac disease (CD) is a permanent intolerance, not an allergy to gluten proteins of wheat, rye, barley, triticale and oats, although recent studies suggest that the latter has no effect in pure in the patient. The ingestion of gluten causes damage to the mucosa of the upper small intestine, digestive symptoms manifesting in extradigestive that disappear when gluten is removed from the diet.

The cause of the disease is unknown but is known to contribute to genetic factors, environmental (gluten intake) and immune systems. EC is estimated to affect 1% of the Spanish, the same prevalence as in other European countries, being more common in women. Still, it is considered under-diagnosed illness: 75% of patients do not know who has celiac disease.


The types of EC

One of the reasons for this under-diagnosis is that there are several ways in which clinical features of celiac disease and many of them were unknown until now:
- Classical: It is rare in adulthood.
- Pauci or monosymptomatic: This is the most common.
- Silent: No clinical manifestations, but histological lesions characteristics.
- Latent: In patients at some point in their lives have filed or will file characteristics of the disease.
- Potential: In patients who, for genetic or immunological characteristics, present a potential risk of developing the disease. The two most prominent are the first-degree relatives and patients with associated diseases, whether autoimmune, neurological and psychiatric disorders and other associations, such as Down syndrome, chronic fatigue syndrome or cystic fibrosis.


Symptoms of CD

The clinical manifestations of CD in a child depend on the age of introduction of gluten in the diet, but the most common are chronic diarrhea, poor appetite, weight parking, vomiting, recurrent abdominal pain, lassitude, irritability, apathy, withdrawal and sadness.

In older children and adolescents, the disease presents as iron deficiency anemia, constipation, abdominal pain, or menstrual irregularities menarche in girls, headaches, joint pain and irregular bowel habits.

In this group, as well as young adults, is fairly common dermatitis herpetiformis, an extremely itchy rash that usually appears symmetrically on the elbows, knees, back and buttocks.

For the adult CHD occurs in different patterns, although the most common symptoms are dyspepsia, irritable bowel syndrome, abdominal pain, recurrent vomiting, bone and joint pain, irritability, fatigue, anxiety or depression.


Biopsy essential
Most important to diagnose the EC is to increase the level of suspicion for associated diseases and clinical findings. From here, you need an HIV study, which will measure and determine the antibody, and a basic analytical study, which will reveal the presence of anemia, iron deficiency or elevation of transaminases.

Still, to confirm the diagnosis is essential to perform an intestinal biopsy, and that alterations in the mucosa are developed sequentially to produce varying degrees of atrophy of the villi. For this test need not be further removed gluten from the diet.


Excluding gluten for life

The treatment of celiac disease passes through the exclusion of gluten from the diet strictly and for life, trying to maintain a healthy and balanced diet. It is imperative that the patient follow a strict diet, and consumption of small amounts of gluten can also cause clinical disorders, biological and histological effects. Full recovery of the intestinal mucosa does not occur immediately after removing gluten from the diet, but can take a year to more children and two adults.

The celiac diet should rely on natural products such as vegetables, meat, fish, eggs, fruit, vegetables and cereals made without gluten, and should avoid, as far as possible, processed foods and / or packaged as is more difficult to ensure the absence of gluten in these cases. Therefore, it is so important an appropriate labeling of foods. Several organizations and associations of CD patients require urgent legislation requiring producers to certify clearly the absence of gluten in their products. Although some countries use the universal symbol for "Product gluten-free" is difficult to identify them all for cross-contamination, ie, being manufactured in the same machine as other gluten products.


The EC is five times more common in children than in adults

A recent study has found that celiac disease is five times more common in boys (1.3%) than in adults (0.3%). This is the first study of the prevalence of CD in the sample population studied is a true reflection of the general population by age and sex between one and 80 years. Published in the journal "Alimentary Pharmacology and Therapeutics", information has been prepared by the Hospital Sant Joan de Deu de Barcelona, ​​Hospital Mutua de Terrassa and the University of Barcelona, ​​in collaboration with the Spanish Society of Clinical Biochemistry and Molecular Pathology (SEQC).

 

Types of food

Foods are classified according to whether they are gluten-free, if they contain contaminated in the manufacturing process or if they contain gluten and therefore can not take celiacs. The latter group includes:
- Bread, wheat, barley, rye.
- Buns, cakes and pies.
- Cookies, cakes and baked goods.
- Pasta (macaroni, noodles ...).
- Dried figs.
- Distilled or fermented drinks from grain (beer and barley water).
- Products manufactured in the composition entering any of the aforementioned meals and any of its forms (starch, meal, protein).
- Communion wafers.

 
Recommendations

- The consumption of manufactured goods involves risk-taking potential.
- You should always read the label of the product is purchased and, if in doubt, consult the latest edition of the list of safe food for coeliacs, regularly updated by the FACE. Also, use caution with imported products, since the criteria or sanitary controls can vary by country of origin.
- Do not consume the bulk products, handmade and are not labeled.
- It has to be careful with food handling and cooking at home, bars, restaurants and school cafeterias.
- Avoid fried foods without gluten in oils which have been previously fried gluten products.
- Use caution with corn or rice flour in bakeries selling or supermarkets without certifying the absence of gluten.
- In families with a celiac, it is always recommended for all members and gluten-free flour or mashed potato flakes.
- When in doubt whether a product contains gluten or not, consume it.

Source: Federation of Celiac Spain (FACE).