Coeliac Disease (CD) is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals and is characterized by the presence of a variable combination of: gluten-dependent clinical manifestations, CD-specific antibodies, HLA haplotypes DQ2 or DQ8 and enteropathy. This definition was updated by ESPGHAN, European Society for Pediatric Gastroenterology, Hepatology and Nutrition in 2012. (Source: celiacos.org)

People suffering from the coeliac illness have an intolerance to gluten, which isgenetic in origin, and which is both chronic and permanent. This problem manifests itself when gluten is ingested, it produces atrophy in the intestinal villi and inflammation of the mucus lining of the small intestine, along with an increase in permeability. People suffering from this illness have intestinal flora that is different from other people.Their bacteria are predominately Gram – while the proportion of Bifidobacterium is reduced. A large proportion of the Gram bacteria stimulate production of the pro-inflammatory cytokines IFN-γ and TNF-αand reduce the production of anti-inflammatory cytokines IL-10. This results in periods of intestinal inflammation, leading to gastrointestinal problems and discomfort.

The cause is an intolerance to the gluten which is found in wheat, barley, rye and oats, and occurs in people who are genetically predisposed to the condition. The coeliac illness is characterized by an inflammatory reaction, based on our immune system, affecting the mucus that lines the small intestine, making absorption of micro- and macro-nutrients very difficult (gluten is a protein with high nutritious value, but is difficult to digest. The reason for this is that our organism does not possess the enzymes that are necessary to completely digest it, and it is these undigested traces which cause intestinal problems).

Chronic diarrhoea, abdominal swelling, nausea and vomiting, general malaise, skin eruptions, constipation, headaches, problems with dental enamel, rickets, weight and muscle loss, anaemia due to iron deficit and stunted growth in children. In some cases, these symptoms may not manifest themselves, making diagnosis more difficult.

Diagnosis is vital when dealing with patients who are sensitive to gluten, because often only looking at the symptoms, it is difficult to distinguish the coeliac illness or allergy to gluten, in spite of there often being a number of manifestations that are not related to the digestive system (pain in extremities, numbness in arms, legs and feet, fatigue, etc.).

Depending on the way in which the gluten intolerance manifests itself, specialists will recommend the most appropriate treatment. The most effective method of dealing with this illness is to eliminate gluten from the patient’s diet, before reintroducing it to observe any reaction. In the case of the coeliac illness or allergy to gluten, it is essential to eliminate gluten completely from the diet. Sufferers should use flours and starches made from corn or rice instead of those made from wheat, barley, oats and rye.