Celiac disease or gluten intolerance is a pathology that remains poorly screened, often due to atypical symptoms that vary from one patient to another. The only way to make sure of this is to completely eliminate it from its diet, after having established with certainty a precise diagnosis.
Celiac disease is an autoimmune chronic inflammatory enteropathy caused by a food antigen, gluten gliadin (protein fraction of cereals). Specifically, it is a permanent intolerance to a protein of gluten, a substance contained in certain cereal products, which causes a destruction of villi of the small intestine. This results in malabsorption of nutrients, especially iron, calcium and folic acid.
According to the French Association of Gluten Intolerant (AFDIAG), one in 100 people can develop this disease in Europe. “In France, only 10 to 20% of cases would be diagnosed today,” she says. In those affected, the signs of the disease may be diarrhea and a worrisome weight loss. However, they may also have unsteady symptoms (muscle cramps, stomatitis, osteoporosis, anemia), the number and intensity of which vary from person to person.
Celiac disease, also called gluten intolerance should not be confused with gluten allergy: the first can go unnoticed, appear gradually and settle down in time when the second causes symptoms of food allergy that occur immediately after ingestion of gluten, considered allergenic. The only treatment for celiac disease is to follow a gluten-free diet for life because there is no medication.
Blood tests are essential
But people who think they are intolerant should not remove it from their diet before they have performed diagnostic tests. The latter is based on blood tests and if necessary a biopsy of the small intestine. First, several types of antibodies are sought: anti-transglutaminase (anti-tTG-IgA) and / or anti-endomysium (EMA) antibodies.
“If they are absent, intolerance to gluten is unlikely.Inversely, the presence of these antibodies reinforces the hypothesis of celiac disease.”, Says the Health Insurance. The diagnosis is confirmed by a biopsy of the small intestine that must be performed before any gluten-free diet. An examination which consists of taking tissue fragments from the part of the small intestine closest to the stomach and whose results make it possible to detect lesions or not
However, when the symptoms of the disease are present, the specific antibodies are high, it is possible that intestinal biopsies are not requested.”, Adds Health Insurance. Finally, once the diagnosis is made, a final assessment is necessary: tests to look for anemia and to measure the bone density in search of osteoporosis. It is after this confirmation that it is recommended to learn to recognize consumable foods and those to proscribe.
When to start a gluten-free diet?
“The definitive diagnosis of celiac disease is made after regression of atrophy of intestinal villi and / or the disappearance of clinical symptoms, following a gluten-free diet,” the High Authority of Health. Despite a diagnostic protocol well established by the latter, progress remains to be made in this area because “80% of the affected subjects are not diagnosed because of minor symptoms or asymptomatic forms (for example: iron deficiency only)”, underlines AFDIAG.
“However, people who are undiagnosed and who do not follow a gluten-free diet are exposed to high risks of cancers of the digestive tract, upper aerodigestive tract and liver, infertility and autoimmune disease. Conversely, those who adopt a gluten-free diet benefit from the disappearance of their symptoms within a few weeks, the healing of damaged intestinal tissues and the reduction of the risk of complications.
AFDIAG also explains that there has been a new type of population in recent years, people who have been tested non-celiac and non-allergic, but who say they feel better if they no longer eat gluten. This is known as sensitivity or hypersensitivity to non-celiac gluten, for which there is currently no clearly established scientific cause and where the role of gluten remains to be demonstrated.
“There are more and more people who eat gluten-free, but paradoxically, they are not necessarily the ones that are proven to need to follow a diet,” the association concludes. Persons practicing it, whether diagnosed or not, exclude all products containing a variety of wheat (durum wheat, spelled, kamut), barley and rye. Thus, they do not consume bread, pasta, biscuits or even sausages and icing sugar, because several foods conceal. [MK]