Gluten intolerance is also called celiac disease. Its origin is unknown, but it is certainly an immune reaction rather than a real intolerance. Update on the disease, its causes and treatment.
Causes still poorly understood
The causes of gluten intolerance are not yet fully understood, however genetic predispositions and environmental factors are certain.
It is a food intolerance of autoimmune origin. In people with this intolerance, absorption of gluten causes damage to the small intestine, inflammation of the intestinal wall. In addition to digestive disorders , celiac disease causes problems with the absorption of nutrients ( calcium , iron , vitamin B9 ) and therefore risks of deficiencies.
The most classic form of gluten intolerance is that of infants and young children. But the disease can also manifest itself in women, usually at the age of 40-50 years and in men, rather around 50-60 years.
This form of food intolerance has a strong hereditary component : if one or more close family members are affected, there is a greater risk of developing gluten intolerance.
Gluten intolerance concerns in 95% of cases people carrying a particular HLA group: HLA-DQ2. The remaining 5% is HLA-DQ8. However, this does not mean that carriers of these groups will necessarily be gluten intolerant.
In addition, it seems that too early introduction of gluten in babies’ diets could influence the development of celiac disease.
The late introduction of gluten (after 6 months) does not seem to decrease the frequency of the disease but delays the consequences.
The onset of clinical disorders
There are four forms of gluten intolerance, which present with different symptoms.
The typical form appears in young children and occurs in the weeks or months following the diversification and introduction of 2nd age flours containing gluten. A break in the weight curve (then the waist curve) is often the earliest sign. The character disorders and digestive disturbances are the other symptoms. The infant becomes indeed sad, listless or hostile.
The appetite is often preserved and wrongly reassures. The stools are bulky , foul, soft, pasty, and shiny. Of vomiting , abdominal bloating are sometimes associated in infants with slender limbs. Of abnormalities of hair and nails are noted.
The atypical form occurs later, even in adulthood. It can be the cause of iron deficiency, frequent abdominal pain, hypoplasia (developmental disorder) of the tooth enamel, bone pain and even multiple miscarriages .
The other two forms appear asymptomatic . These are silent celiac disease and potential celiac disease:
The first can be diagnosed during a medical examination. If it appears asymptomatic, the establishment of a treatment still brings about a physical and psychological improvement;
The potential form of celiac disease concerns people in whom serological markers are detected (by a blood test), but whose biopsy (small sample of the digestive mucosa by endoscopy) is normal. But there is a risk of intestinal damage if one does not carry out the gluten-free diet.
Iron deficiency anemia and hypoprotidemia are suggestive. Serological tests are very reliable. The assay of anti-gliadin antibodies (AAG) has come into common practice. In young children, the measurement of anti-IgA antigliadin antibodies (IgA-AG) is sensitive and specific. In older children, the results are less reliable and other assays are required: anti-reticulin type IgA antibody (AAR), anti-endomysium type IgA antibody (EMA).
The biological assessment also includes the dosage of fat-soluble vitamins (A and E) which assesses the malabsorption of fats. Intestinal permeability tests (mannitol and lactulose) are starting to be used in France. The intestinal biopsy performed under endoscopy remains the essential examination to confirm the diagnosis, verify the effectiveness of the diet and assess the effect of reintroducing gluten (provocation test).
The total villous atrophy allows histological diagnosis microscope.
Note that the antibody test will be negative after the gluten-free diet. In addition, the diagnosis of celiac disease can be confirmed by seeing an improvement in the gluten-free diet.
Gluten intolerance, if left untreated, can cause various complications.
In particular, it can lead to the development of irritable bowel syndrome or lymphocytic colitis. Celiac disease can also cause liver problems such as primary biliary cirrhosis.
An increased risk of cancer, as a lymphoma , adenocarcinoma of the small intestine, a primary liver cancer , a colorectal cancer or pancreatic cancer , has been detected.
Other attacks are also possible, such as hormonal diseases ( diabetes , thyroid abnormalities), cutaneous-mucous, osteo-articular, neurological and gynecological damage.
Complications can also arise when there is resistance to the gluten-free diet . We speak of refractory sprue.
There is no treatment (medication) for celiac disease. The only way not to suffer the inconvenience is to restrict yourself to a strict gluten-free diet for life. Less than 50 mg per day is recommended, while in Europe the consumption is 10 to 20 g per day.
The beginnings of the diet are often difficult for people with gluten intolerance. They are faced with not always knowing which products are allowed. It is therefore strongly recommended to call in a dietitian.
The aim of treatment and therefore of the gluten-free diet is to correct clinical signs and reduce the risk of complications.
In general, the symptoms disappear quickly with the diet. But if there is a deviation, they reappear just as quickly. This is why the diet is generally followed diligently.
The prohibited cereals are:
The Rye ;
All products containing these cereals should therefore be banned.