|
 OTHER NAMES
- Celiaquía,
- Not tropical Sprue,
- Enteropatía for gluten.
There are other illnesses related intolerantly to the gluten as it is Dermatitis Herpetiforme.
DEFINITION
The coeliac illness or sprue, it is an inflammatory illness of the small intestine produced by the consumption of wheat in individuals predisposed (genetically).
SYMPTOMS
The beginning of the illness is usually about two years of age, after the introduction of the wheat in the diet, and in the adults between 30 and 40 years. There takes place a leveling of the intestinal surface diminishing the area of absorption of the food, the loss of this one surface is the one that will delimit the symptoms grade in every individual.
Symptoms of the coeliac illness:
- In many cases it can happen practically unnoticed, until his complications are evident.
- The most habitual thing there is the presence of a chronic diarrhea with malabsorcion.
- Loss of weight.
- Nutritional shortcomings.
- Anemia for iron shortcoming.
The abdominal pain can be an appellant and associate to flatulence abdominal distension, and abnormal intestinal movements.
The anemia takes place for malabsorcion of iron, of acid fólico and/or of vitamin B12. Sometimes it collaborates to an arthritis picture with pain, rigidity and weariness. Bony injuries can appear and tetanias
Symptoms of the nervous system appear also with sensation of intense heat and itch in the skin of the extremities, muscular contractions and difficulty to stay standing, with irritability and alterations in the memory.
CAUSES
Mechanisms involved in the intolerance to the gluten:
- Absence of digestive enzymes (glutaminasa intestinal).
- Production of Antibodies anti-prolamina, ó to her fragments.
- Increase of the intestinal permeability to macromolecules and antigenic proteins.
- I increase in the mediators' production (histamine, serotonina, cininas, prostaglandin, and interleukinas).
The relatives of the first grade have a predisposition that finds in the chromosome 6, and the most frequent scoreboard is the associate to the HLA DQw2.
WHAT IS THE GLUTEN?
The gluten is a miscellany of individual proteins, classified under two groups, the Prolaminas and the Glutelinas. The principal component of the gluten is the prolamina of the wheat called Gliadina.
The prolaminas of the different cereals are:
| Cereals |
Type of Prolamina |
Suppressed % |
| the wheat |
Gliadina |
69 % |
| the hundredth one |
Secalinina |
30-50 % |
| the oats |
Avenina |
16 % |
| the barley |
Hordeina |
46-52 % |
| the millet |
Panicina |
40 % |
| the corn |
Ziena |
55 % |
| the rice |
Orzenina |
5 % |
| the sorghum |
Kafirina |
52 % |
DIAGNOSIS
The diagnosis is realized by the measurement of specific antibodies in the blood, by an intestine biopsy and for the symptoms.
The biopsy is usually duodenal, although that of the yeyuno will be more sensitive.
There appear three different models that change according to the clinical presentation:
- The infiltration of the downy epithelium with lymphocytes, with normal fluffinesses and with crypts. This model finds in 40 % of individuals with Dermatitis Herpetiforme and a patients' small portion with affectation intestinal and in relatives of affected that is asymptomatic.
- Elongations of the crypts with leveling and with inflammatory cells in the proper plate. This model meets clásicamente in individuals coeliac illness with intestinal symptoms, in relatives of affected asymptomatic, and in individuals Dermatitis Herpetiforme. In most of these individuals, the treatment with a free gluten diet produces the improvement of the fluffinesses and the architecture of the crypts that becomes normal or almost normal.
- Entire leveling of the mucous membrane with absence of fluffinesses and with very small crypts. It is in affected patients more severely. It is usually refractory to the free gluten diet, and the injury is not reversible. It are patient that need of nutritive supplements route parenteral.
The biopsy typical and repeated to avoid false positives of intestinal infections, with injuries produced by the lactose. Also it is necessary to bear in mind that the patients in reference or with intermittent symptoms they can have normal the biopsy and the results of the analyses although they remain very sensitive to some prolamina.
BLOOD TEST
- The Antibodies IgG anti-gliadina (AGA), which are not specifics of the Coeliac illness.
- The antibodies IgA anti-gliadina (AGA), which sometimes (2 %) do not appear since an IgA deficit exists.
Between both antibodies they obtain a sensibility (patients detect) of 96-97 % and an especificidad (they do not appear in healthy) of 96 %.
The antibodies antireticulina (ALTAR) can be IgG that there are no specifics of the coeliac illness, and the IgA that reach a sensibility (patients detect) from 97 % to 98 %. In the children these values are less specific.
Also another two antibodies exist:
- Antibodies IgA - antiendomisiales (LOVE)
- Antibodies anti-yeyuno human being (FIGHTS ON HORSEBACK)
Both with a sensibility (patients detect) of 100 %. In any case in children younger than 2 years this especificidad (they do not appear in healthy) is minor. Also when a deficit of IgA exists these antibodies lose his especificidad.
With this panel of antibodies (IgG AGA, IgA AGA, and IgA AME) we can come to a value predictivo positive of 99,3 % if they all are positive and a value predictivo negatively of 99,6 % when they all were negative.
All these antibodies tend to negativizarse with the diet of exclusion of gluten, serve to observe the evolution of the possible intestinal symptoms but not of extraintestinal symptoms.
In any case the biopsy is necessary to confirm the diagnosis. Remaining the clinic like essential and being the most important test of intolerance of gluten it is the symptoms reference when the cereals are eliminated by a period of 3-6 weeks.
The achievement of diets of exclusion of gluten with biopsies in the phases without diet in 3 or more occasions is usually the most suitable diagnostic method.
TREATMENT
A diet exempt from gluten is realized.
After a free diet of gluten (wheat flours) in two weeks an improvement of the symptoms takes place in most cases.
If it does not improve it can be why the diet is not suitable or because complications appear linfomatosas.
In asymptomatic individuals the diet is realized also because the illness tends to deteriorate if it is not done and because the linfomas incidence and adenocarcinomas it increases, seeming to coincide the increase of these tumors with the grade of intestinal inflammation.
For it it is not clear that the individuals with serología print but without intestinal inflammation they should take this diet.
Illnesses parallel to the chronic diarrhea in the intolerance to the gluten. Not always associated with the intestinal alteration.
- Syndrome hiperquinético
- Epilepsies
- Alterations of the attention
- Intestinal Linfomas
- Intestinal Adenocarcinomas
- Dermatitis herpetiforme
- Schizophrenia
WHAT DOCTOR CAN TREAT ME?
|
DENOMINATION 
