What is Celiac Disease?

Celiac disease is an immune system disorder characterized by chronic damage to various tissues on the intestinal surface, caused by both environmental and genetic factors. For genetically susceptible individuals, consuming certain grains like barley, wheat, and rye triggers a reaction in the body, and the protein called gluten found in these grains is perceived as a completely toxic substance by the immune system. Initially considered a gastrointestinal disease, this condition has been extensively studied in recent years, revealing that it significantly affects many systems, including neurological, psychological, hormonal, rheumatological, and cardiological systems. Lack of information regarding celiac disease can delay its diagnosis, which can particularly lead to growth and developmental delays during childhood. Therefore, having accurate knowledge about celiac disease and gluten intolerance is extremely important to support a healthy developmental process.

Celiac disease is an immune system disorder characterized by chronic damage to various tissues on the intestinal surface, caused by both environmental and genetic factors. For genetically susceptible individuals, consuming certain grains like barley, wheat, and rye triggers a reaction in the body, and the protein called gluten found in these grains is perceived as a completely toxic substance by the immune system. Initially considered a gastrointestinal disease, this condition has been extensively studied in recent years, revealing that it significantly affects many systems, including neurological, psychological, hormonal, rheumatological, and cardiological systems. Lack of information regarding celiac disease can delay its diagnosis, which can particularly lead to growth and developmental delays during childhood. Therefore, having accurate knowledge about celiac disease and gluten intolerance is extremely important to support a healthy developmental process.

What is Celiac Disease?

The healthy intestinal surface is covered with structures called villi, which facilitate the movement of consumed food within the intestines and ensure the absorption of digested nutrients. In celiac disease, gluten consumption causes damage to these valuable structures located in the intestinal mucosa, disrupting healthy intestinal function. When an individual consumes gluten-containing foods, peptides known as gliadins within the gluten protein combine with molecules called "Human Leukocyte Antigen" (HLA) class II, initiating a reaction in the immune system. Gliadin is regarded as "toxic" by the immune cells of celiac patients, leading to a strong humoral and cytotoxic cellular immune response. The gliadin molecule is indeed entirely toxic. A molecular structure called the "33-mer peptide," found within it, is a precursor molecule that triggers the inflammatory response in genetically susceptible individuals. The intake of this toxic molecule results in the formation of antibodies such as anti-gliadin (AGA), anti-endomysial (EMA), anti-tissue transglutaminase (Anti dTG), anti-reticulin (ARA), and others in the blood. The autoimmune response developed against these antibodies targets not only intestinal cells but also the tissue transglutaminase enzyme found in many other organs. Therefore, celiac disease is not merely a digestive system disorder but a complex disease affecting all body systems in gluten-sensitive individuals.

What are the Symptoms of Celiac Disease?

The initial symptoms of celiac disease are generally changes observed in the digestive system. Loss of appetite, chronic diarrhea or constipation, recurrent abdominal pain and vomiting, unexplained short stature, delayed puberty, treatment-resistant and undiagnosed iron deficiency anemia, and osteoporosis are major symptoms indicating celiac disease.

What Causes Celiac Disease?

Genetic factors play a significant role in the onset of celiac disease, but environmental factors are also extremely important. Even in genetically susceptible individuals, there are no signs of the disease as long as gluten is not consumed in their diet. Therefore, celiac disease is frequently encountered in populations that predominantly consume wheat and other gluten-containing grains. The duration of exposure to gluten is directly proportional to the body’s immune response and the development of the disease. Upon ingestion of gluten, the toxic gliadin peptides are released, triggering the immune system’s reaction.

What Symptoms are Associated with Celiac Disease?

The clinical picture of celiac disease can vary significantly. Damage to the villi leads to malabsorption in the small intestine, affecting the functioning of many body systems, especially the digestive system. Common clinical symptoms associated with celiac disease include:

• The stool appearing greasy and pale, along with an increased frequency and volume of bowel movements, is the most important indicator of celiac disease.
• In classic celiac disease, most symptoms are related to the digestive system and often emerge during the introduction of complementary foods between the ages of 6 and 24 months. Typically, symptoms such as chronic diarrhea or loose stools, nausea, vomiting, loss of appetite, abdominal pain, and gas complaints occur alongside growth and developmental delays.
• Atypical celiac disease, characterized by extra-digestive symptoms, primarily appears in children aged 5-7 and adults. Commonly observed symptoms include short stature, delayed puberty, enamel defects in teeth, recurrent oral aphthae, iron deficiency anemia that does not respond well to treatment and cannot be diagnosed, skeletal disorders related to osteoporosis or low bone density, cardiac muscle disorders such as cardiomyopathy, chronic arthritis, liver function abnormalities, and neurological disorders, in addition to recurrent abdominal pain, nausea and vomiting, feelings of abdominal bloating, constipation, and gastroesophageal reflux.
• Another commonly observed symptom, especially in adults, is skin rashes known as dermatitis herpetiformis, which manifests as maculopapular rashes primarily on the arms, legs, buttocks, face, neck, and body surfaces.
• Various dermatological diseases, such as linear IgA dermatosis, hereditary angioedema, cutaneous vasculitis, erythema nodosum, urticaria, vitiligo, and alopecia areata, may also occur as a result of the immune response.
• Additionally, oral and/or genital mucosal lesions resembling aphthae may arise due to deficiencies in iron, zinc, folic acid, and vitamin B12.

How is Celiac Disease Diagnosed?

Celiac disease is a complex condition that persists throughout life and significantly alters an individual’s dietary habits, making accurate diagnosis crucial. In the presence of classical or atypical symptoms, the initial step in diagnosis is to detect the presence of antibodies in the blood. Tests that search for antibodies developed against gluten in foods and damage caused to the intestinal mucosa are considered the most valuable method for screening, while small intestine biopsy is the gold standard for diagnosis. Especially in cases of atypical celiac disease that do not present clear digestive symptoms, intestinal biopsy is preferred to eliminate suspicion.

Celiac Disease Treatment

Celiac disease is a condition that occurs due to the consumption of gluten protein in individuals with a genetic predisposition, making the only accepted treatment option lifelong gluten-free nutrition. As long as the individual does not consume gluten-containing foods, no disease will develop in the body, and healthy intestinal function will be maintained. Individuals diagnosed with celiac disease should prefer options like corn and rice, which do not contain toxic prolamins, instead of gluten-containing grains.

To adhere correctly to a gluten-free diet, it is important to prevent contamination with gluten during food preparation and to prepare meals in environments completely free of gluten.

How to Prevent Celiac Disease?

Since the disease manifests through gluten consumption, the prevention of celiac disease is only possible by maintaining a gluten-free diet. Even if a genetically predisposed person is diagnosed with celiac disease through screening, they can prevent the development of the disease by adhering to a gluten-free diet. Individuals who avoid gluten do not experience gastrointestinal issues such as diarrhea, abdominal pain, nausea, or bloating; there is no damage to the intestinal surface, and absorption-related disorders do not occur. Therefore, even if someone is diagnosed with celiac disease, also known as gluten enteropathy, the disease can be prevented

What Happens if One Does Not Follow a Gluten-Free Diet?

In the classic stage of celiac disease, distinct complaints related to the digestive system significantly impair the individual's quality of life, facilitating diagnosis. However, in atypical celiac disease, the symptoms are not easily noticeable, and treatment with a gluten-free diet is delayed. In this case, not adhering to a gluten-free diet can lead to serious disorders in many systems of the body.

Celiac disease is a condition directly related to the body's autoimmune response mechanism. Therefore, prolonged duration of the disease can lead to disturbances in the body's autoantibody production mechanism, making the individual prone to other autoimmune diseases. Common serious autoimmune diseases include multiple sclerosis (MS), rheumatoid arthritis, insulin-dependent diabetes, systemic lupus erythematosus (SLE), pemphigus vulgaris, and ankylosing spondylitis.

The damage to the intestinal surface and absorption disorder associated with celiac disease leads to nutritional deficiencies, negatively affecting the functioning of many body systems. As the disease progresses, some endocrine disorders may occur, and it has been observed that women who do not follow a gluten-free diet have an increased risk of miscarriage and frequently encounter early birth complications.

Failure to adhere to a gluten-free diet increases the likelihood of developing malignant tumors in the body. In other words, it is possible to say that individuals with celiac disease who refuse treatment are in a high-risk group for various cancers.

For further inquiries about celiac disease, you can seek support from healthcare institutions and consult with specialist physicians.