Celiac disease: what is it, how to recognize it and treat it

Celiac disease — this autoimmune disease, in which the body perceives gluten (a protein found in wheat, rye, and barley) as a dangerous substance. In response, the immune system begins to attack its own cells in the lining of the small intestine, destroying the villi responsible for absorbing nutrients.

According to estimates World Health Organization (WHO), celiac disease affects 0.5 to 11% of the world's population, but in most people the disease remains undiagnosed. Modern medicine considers it as lifelong condition, which requires a complete rejection of gluten.

How does celiac disease occur?

Celiac disease has genetic nature. People with certain genes (HLA-DQ2 or HLA-DQ8) are more likely to have an immune reaction to gluten. When they consume foods containing it, a chain of autoimmune processes is triggered in such people.

The body begins to produce antibodies that attack the cells of the intestinal mucosa. Over time, the villi — microscopic protrusions that increase the absorption surface area — disappear. As a result, food ceases to be digested normally, and even with a normal appetite, the person suffers from nutrient deficiency.

How celiac disease affects the body

It's not just an intestinal disease. Because it disrupts nutrient absorption, celiac disease affects all body systems:

• Digestive system: diarrhea, bloating, abdominal pain, fatty stools.

• Hematopoietic system: anemia due to deficiency of iron, folic acid, vitamin B12.

• Skeletal system: osteopenia or osteoporosis due to lack of calcium and vitamin D.

• Skin: itching, dermatitis (herpetiform rash).

• Nervous system: headache, depression, anxiety, difficulty concentrating, paresthesia (numbness of the extremities).

• Hormonal system: in women - menstrual cycle disorders, in men - decreased testosterone.

Celiac disease can even have asymptomatic course, but at the same time continues to destroy the intestinal mucosa. That is why it is important to undergo diagnostics even with minimal complaints.

Symptoms of celiac disease in children and adults

Sometimes the only manifestation may be skin rash, vitamin deficiency or infertility — and the person doesn't even suspect there is a problem with the intestines.

How is celiac disease diagnosed?

1. Blood test for antibodies:

   • antibodies to tissue transglutaminase (anti-tTG IgA);

   • endomysium antibodies (EMA);

   • antibodies to deamidated gliadin (DGP).
     High levels of these antibodies indicate an immune reaction to gluten.

2. Genetic testing:
   Detection of the HLA-DQ2 or HLA-DQ8 genes confirms susceptibility to the disease.

3. Endoscopy and biopsy of the small intestine:
   This is the most accurate method. The doctor takes several samples of the mucosa for examination under a microscope. If the villi are absent or flattened, the diagnosis is confirmed.

4. Monitoring after a gluten-free diet:
   If symptoms disappear after 6–12 weeks without gluten, this is also indicative of celiac disease.

Importantly: You should not eliminate gluten from your diet before the tests, otherwise the results may be false negative.

Celiac disease vs. allergy vs. gluten intolerance

Celiac disease treatment

For today the only effective treatment method is a complete lifelong gluten-free diet. This means completely avoiding all products containing wheat, rye, barley, and even traces of gluten.

After switching to such a diet, after a few weeks:

• abdominal pain decreases;

• skin manifestations disappear;

• stool normalizes;

• Mood and energy improve.

After 6–12 months, the intestinal mucosa is completely restored in most patients.

Additionally, the doctor may prescribe:

• iron, folic acid, vitamin D, calcium — to restore deficits;

• probiotics — to maintain microflora;

• B vitamins — to normalize energy metabolism;

• regular antibody monitoring — to assess the effectiveness of the diet.

What does a gluten-free diet look like?

The modern food industry offers a wide selection of gluten-free products, so following a diet is becoming increasingly easier.

How to avoid mistakes on a gluten-free diet

• Avoid cross-contamination — even a crumb of regular bread can cause a reaction.

• Don't assume gluten-free products are automatically healthy: they may contain a lot of sugar or fat.

• Contact us nutritionist, to avoid nutrient deficiencies.

• Check the composition not only of the products, but also medicines — the tablets may contain gluten as an excipient.

The psychological aspect of celiac disease

Living gluten-free is not only a physical restriction, but also an emotional burden. Many people experience fear of eating out, difficulties with food while traveling, and social isolation.
Psychologists recommend:

• lead food diary and celebrate positive changes;

• communicate with other people who have celiac disease (support groups);

• Don't be shy about announcing your diagnosis in restaurants - it's not a fad, it's a matter of health.

New treatment directions

Scientists Mayo Clinic and FDA are investigating new therapies:

• enzymes that break down gluten into safe compounds;

• vaccines that modulate the immune response to gluten;

• medications that block the penetration of gluten peptides through the intestinal mucosa.

Although these methods do not yet replace diet, they offer hope for future improvements in patients' lives.

Life expectancy with celiac disease

Provided that a gluten-free diet is fully followed, the prognosis is favorable. People can live a full life, play sports, travel, and have children.
Without treatment, celiac disease can lead to complications:

• anemia, osteoporosis, infertility;

• nutrient deficiency;

• increased risk of bowel cancer or lymphoma.

Ago early diagnosis і discipline in nutrition — the key to a healthy life.

Sources

1. World Health Organization (WHO). Celiac Disease: Global Burden and Clinical Guidelines, 2024.

2. Mayo Clinic. Celiac Disease Overview: Diagnosis and Management, 2023.

3. US Food and Drug Administration (FDA). Regulatory Framework for Gluten-Free Labeling, 2024.