Prof. Dr. Şafak Kızıltaş
Prof. Dr. Şafak Kızıltaş
Celiac disease, which can occur in any period from infancy to old age, is known as "thousand and one faces" due to its symptoms and the discomforts it causes. The gluten found in wheat, barley, oats and rye causes damage to the small intestines in people with a genetic predisposition. The most effective treatment for the disease is to keep away from gluten. Below are some common misconceptions about celiac, which lie at the root of many diseases such as migraine, depression, osteoporosis, infertility, and irritable bowel syndrome:
Celiac is a modern age disease!
No, on the contrary, it is a disease that dates back to before the birth of Christ. Celiac, the world's most common genetic disease, is a disease that catches the small intestine and many organs and affects the immune system. The traces of the disease, named after the word “coeliaca”, meaning abdomen in ancient Greek, was found even in the 1st century BC. Archaeological remains show that humans have caught this disease since they began feeding on the first improved wheat in Mesopotamia. The first diagnosis was made in 1888 when the British pathologist Samuel Gee showed histological findings of the disease in small intestine biopsies. In the 1950s, it became clear that the causative agent of the disease was gluten in wheat.
It is not a common disease!
On the contrary, it is the most common disease in the world. The prevalence of the disease in the first years of its definition was thought to be one in 4,000 to 5,000 people. However, studies conducted today reveal that celiac disease is found in one out of every 100 people in many societies. This rate rises to one in 60-70 people in Northern Europe and 5-6 percent in Western Europe. Considering the number of patients identified, it can be compared to the tip of an iceberg. The number of undetected patients is thought to be higher.
Celiac is not a genetic disease!
No! This is an inherited disease. If celiac is found in one of the monozygotic twins, it is also seen in 75 percent of the other twin. It is found in 20% of first-degree and 5% of second-degree relatives.
It shows up in childhood!
There may be many manifestations of this disease. While it can occur in early periods such as infancy and early childhood, there are also late cases that can be defined at the ages of mid-seventies and mid-eighties. In other words, celiac disease can be seen at any age.
The only symptoms are swelling and abdominal pain.
Celiac has many symptoms. The classic findings are abdominal pain, diarrhea, anemia, inability to gain weight, short stature, physical and mental retardation, osteoporosis and problems in tooth enamel.
Celiac only causes disease in the digestive system.
On the contrary, celiac can cause various diseases in all body systems. In women, celiac may cause menstrual irregularity, infertility or frequent miscarriages during pregnancy. It can cause many different diseases. Celiac can cause many problems such as liver function disorders, cardiac muscle disorder, deficiency in vitamin D and B vitamins, folic acid deficiency, dermatitis, ulcers, mouth ulcers, neurological disorders, depression, and kidney and joint diseases.
Irritable bowel syndrome is caused by celiac.
Irritable bowel syndrome is a different disease. However, it is known that the prevalence of celiac increases up to 2-3% in patients with dyspepsia (abdominal pain, tension, early satiety, loss of appetite, nausea, belching) and irritable bowel syndrome.
Reducing gluten cures celiac.
The intake of gluten, even as little as one-eighth of a teaspoon of flour, triggers the disease. The mechanism is as follows: During the absorption of food in the intestines, the body's defense mechanism begins to fight against gluten and the intestinal wall gets damaged when antibodies attack the brush-like surface in the small intestine. Due to this damage, nutrients are excreted through the digestive tract without being absorbed. Consuming gluten-containing foods less alleviates the problem a bit, but does not cure it. Celiac patients have to eat foods that do not contain any gluten in order to avoid this problem.
It is enough to have a blood test for diagnosis!
A blood test alone is not enough. The most important method for diagnosis is the physician's examination, listening to the patient's history well, and physician awareness. Celiac antibodies are looked for in blood tests. A biopsy must be conducted on the small intestine because the positivity rate of celiac antibodies (Anti-EMA IgA, Anti-ttg IgA) is high in the disease. Sometimes, small intestine biopsies may not be sufficient. In such cases, it is recommended to determine the tissue type (HLA DQ2-HLA DQ8). These tissue types are positive in 95 percent of celiac patients, so it plays an important role in showing whether or not Celiac disease is present.
Keeping away from gluten-containing foods is enough.
Although the most effective method in the treatment of celiac disease is keeping away from foods containing gluten, cleaning and cosmetic products containing gluten have to be avoided as well.
You can take a break from the gluten-free diet from time to time.
The most important step in the treatment of this disease is to stop gluten consumption. Moreover, this diet must be continued for a lifetime without any interruption. The small intestine of people who take care of their diet begins to get better within 6-12 weeks. At the end of one year, 70 percent of the patients recover completely. Some drugs that suppress the immune system are used in patients who do not get better in a year.