CELIAC, A DISEASE MORE AND MORE WIDESPREAD.
The term celiac derives from the greek koilía, cavity, stomach, also known as celiac disease or celiac sprue, is a permanent intolerance to gliadin. Gliadin is the alcohol-soluble component of gluten, a mixture of proteins found in wheat, barley, rye, spelled, kamut. While oats seems to be tolerated in small amounts by most patients.
All foods derived from these cereals containing gluten or as a result of contamination must be considered toxic for the patients suffering from this disease.
Gluten intolerance cause serious injury to the mucosa of the small intestine, which were resolved by eliminating gluten from the diet. The reversibility of the disease is closely related to not taking part of the subject of celiac foods containing gluten or otherwise contaminated by it. Celiac disease is not a cure: the subject celiac remain so throughout his life, the only cure is to adopt a strict gluten-free diet.
CAUSES OF CELIAC:
Among the causes of celiac disease include both environmental factors and genetic factors.
Environmental factors are represented by gluten, which is the protein component of wheat flour, barley, rye and oats.
The importance of genetic factors in the pathogenesis of celiac disease is confirmed by studies of relatives of celiac patients have shown a prevalence of celiac disease 10% among first-degree relatives.
EVENTS OF CELIAC:
Celiac disease can present with a wide spectrum of clinical manifestations ranging from signs and symptoms of a frank malabsorption plaid soft.
There is talk of celiac disease increased in the presence of typical symptoms of severe malabsorption, namely diarrhea, steatorrhea, and marked weight loss.
They differ from celiac disease lower in the case of minor symptoms and extraintestinal (anemia, osteoporosis, skin lesions typical, infertility, miscarriages, etc).
It speaks of silent celiac disease in those patients diagnosed, usually among family members, who do not have any symptoms.
DIAGNOSIS OF CELIAC
The diagnosis of celiac disease is based on gastroscopy with duodenal biopsy and the detection of specific antibodies for celiac disease (deamidated gliadin, endomysial and tissue transglutaminase). Duodenal biopsy must show the histological lesions characteristic for celiac disease and that the intestinal villous atrophy, hypertrophy of the crypts and the increase in the number of intraepithelial lymphocytes. The development of these lesions, however, is a dynamic process that can occur in varying degrees and then with lesions more or less marked.
To make diagnosis is therefore necessary to demonstrate that the patient is also positive for antibodies specific for celiac disease, especially endomysial and tissue transglutaminase.
TREATMENT OF CELIAC
At present, the gluten-free diet is the only treatment but are investigating other therapeutic strategies. The gluten-free diet must be very strict since sufficient minimum amount of gluten to prevent the histological improvement and must be followed scrupulously throughout life. It is necessary to eliminate from the diet not only foods containing wheat and dairy products, but also those containing barley, rye and oats. Initially it may be difficult to stick to a strict gluten-free diet because gluten can be in a variety of foods in the diet normal wheat flour is one of the most common ingredients in various food products. It is necessary, therefore, properly inform the patient to prevent inadvertent infringements and offer, with regular checks, a ongoing assistance.
In forms that do not respond to a gluten-free diet alone, we resort to immunosuppressive treatment.
The hinge for the proper treatment of celiac disease is adherence to a gluten-free diet, which is able to eliminate the symptoms of the disease in a few months. But this means that patients must be evaluated for the effects of this diet, and should therefore be checked regularly for osteoporosis, thyroid dysfunction, and deficiencies of folic acid, vitamin B12, for fat-soluble vitamins and iron, and must be treated appropriately in the event of deficiencies.
Celiac disease is fought then with a gluten-free diet: rice, oats (in testing) corn, buckwheat, millet, soy, amaranth, quinoa in combination with fruits, vegetables, fish, meat, cheese, vegetables and more, however, can be easily incorporated in the daily diet of celiac. It is worth pointing out that a person with celiac disease, a condition to observe a proper diet, can lead a completely normal life.
According to studies done the maximum concentration of a celiac gluten that can be used in a food is 20 ppm (parts per million), a threshold beyond which the gluten is toxic: the current legislation europeasancisce this limit to define a gluten-free product.
It is crucial to understand how a minimum of contact with those foods containing gluten for celiac can contaminate the latter, for example, use the same utensils to stir the pasta cooking in different pots must be avoided. The ingestion of a small amount of gluten can override the diet, so it is important to ensure that the non-celiac ingests foods that may contain gluten in any form (eg wheat starch. Often used as a thickener and structuring in many foods; for the same reason be added to pharmaceutical preparations in tablet form, of which coeliacs must necessarily check the ingredients under the heading excipients). You should also avoid beer (although there are some brands and types on the market for gluten-free), and pay attention to the espresso bar (because it may be contaminated with barley), spices, sugar, usually pre-cooked food, prepared food flavored (eg. yoghurts with fruit) or flavored drinks. For orientation, there is a Handbook of Food that is provided free of charge by the Italian Celiac for celiacs, containing a list of all the gluten-free foods by category.
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