Celiac disease

Celiac disease is a disease characterized by disorders of digestion, relating to the violation of absorption in the small intestine of fats and carbohydrates due to intolerance gliadin - protein gluten wheat, rye, oats.
A disease caused by deficiency of enzyme systems intestinal cells, necessary for the cleavage of peptide gluten and development in the body of the child of precipitating antibodies to gliadin.
Celiac disease is developing mostly in children aged 2 to 3 years. There is a decrease of appetite, General weakness, paleness of skin, anemia, muscle hypotonia, depletion. Lagging behind in growth, osteoporosis, rachitic changes skeleton, caries of teeth, nails remind watch glasses. In General physical retardation of development and significant depletion is evident big belly, increased flatulence and high content of fluid in the advanced intestinal loops (pseudoacacia). Cal whitish color brilliant, generous, contains a lot of neutral fat and fatty acids.
Celiac disease is secondary develop multivitamin failure, hypoproteinemia, susceptibility to infections. The level of calcium, phosphorus, alkaline phosphatase, cholesterol, blood lipid less than the normal acidity of gastric juice reduced. The disease has an undulating course.
The above symptoms of celiac disease sometimes seen as symptoms of chronic, persistent enterocolitis, chronic malnutrition.
In the diagnosis of celiac disease must avoid a protracted form of dysentery, tuberculosis intestinal damage, mucoviscidosis (see). Forecast of celiac disease more favorable.
Treatment. I appoint gliadin free diet, i.e. food ration exclude products containing wheat, rye and oat flour. Limit fats and starch. In the food consumed breadmade from rice, corn, buckwheat and soy flour. The skimmed milk is recommended. Drug therapy includes a complex of vitamins in the highest dose; Pancreatin 0.25 g 3 times a day, methionine 0.3 g 3 times a day for 2 weeks, glycyrrhizinate calcium 0.15 g 3 times a day, reduced iron 0.15 g 3 times a day, nerobolum 0.1 mg/kg of body weight of the child in two installments, anteroseptal 0.1-0.2 g 4 times a day. Shows massage and medical gymnastics.

Celiac disease [synonym disease GI - Garter - Eibner (S. Gee, S. A. Herter, O. Heubner)] is a syndrome characterized by delay of the child in growth, a significant increase in the abdomen General exhaustion, abundant feces containing large amounts of fat due to malabsorption him in the gut. Similar clinical manifestations at spru (see) in adults and in cystic fibrosis (see). Detailed clinical picture of the disease is more common in children from the second year of life.
The etiology and pathogenesis of the disease is unclear. Thus, among the reasons cited: secretory, absorption and motor weakness of the entire gastrointestinal tract, plurigenera failure, particularly the adrenal insufficiency. Perhaps have value for constitutional and hereditary aspects. Stressing the importance of transferred gastrointestinal diseases, vitamin deficiency, congenital malformations of the nervous ganglia of the intestine (gut infantilism) or their damage after inflammatory processes in the gut, and disorders of the nervous regulation of the intestine. Hi, Herter, Garner believed that in the pathogenesis of celiac disease more the role of food rich in carbohydrates. However, in the 50-ies of the 20 century has been proven intolerance celiac disease to the protein gluten free cereals (wheat, rye, oats) - gliadin.
On the basis of long wavy course of the disease, and identify patients precipitating antibodies against gliadin put forward the theory according to which celiac disease and allergic disease (the allergen is gliadin). This theory, widely spread, defiantly was confirmed by the fact that full shutdown of gliadin of the diet of patients resulted in clinical improvement. However, skin tests with extracts of wheat was negative; not found parallelism between immunological reactions and disease. According to Sheldon, Ali (W. Sheldon, S. Alvey), celiac disease there are no specific intracellular enzymes, capable to dezaminirovanie gluten peptides. The pathogenesis of the disease has also been associated with congenital deficiency R-lipoproteins and change their properties. Kezer (N. Kaser) distinguishes true idiopathic disease from its pseudoform to which relates to food allergies, chronic enteritis and malformations.
There are primary congenital and secondary celiac disease, developing due to prolonged diarrhea different etiology; the latter form quickly responds to treatment, in contrast to the primary. Apparently, symptoms of celiac disease can be caused by various reasons leading to inferiority motor, enzymatic and absorption of activity of the gastrointestinal tract.

The clinical picture. In General physical retardation and significant depletion is evident big belly (Fig. 1). The intestine is usually sharply swollen gases, visible reinforced peristalsis. Palpation you can determine the fluctuation due to accumulation in the advanced intestinal loops fluid, disappearing after defecation (pseudoacacia). The chair is very rich, friable, frothy, foul-smelling, whitish, with typical greasy luster because of high content of fat. Easily find available starch grains, painted in blue logoiski solution. Fat excretion with faeces sharply increased; in severe cases, can be negative lipid balance. The weight of the chair during the day can reach 1 - 1,5 kg
Celiac disease is characterized by a wavy course. During exacerbations observed increasing and worsening stools, loss of appetite, weight, significant neuro-vegetative disorders with a predominance of parasympathetic tone of.
Sick children usually sluggish, dynamiczny, with slow movements, irritable, tearful, not tolerate changes in the surrounding environment. Disorders of the Central nervous system manifested in disorders of sleep, appetite, and behavior, perversion cardiac, cerebral reflexes and vascular reactions, and in sharp violation of the regulation of motility of the gastrointestinal tract.
The radiological examination of the gastrointestinal tract are discovered numerous horizontal fluid levels in the subtle and especially in the large intestine. Visible parts of spasm and atony with sharp bloating. Especially inflated and atonic colon (Fig. 2).

Fig. 1. The child is 2 years 2 months; patient celiac disease.
Fig. 2. X-rays of the same patient, as in Fig. 1: numerous horizontal fluid levels, significant flatulence.

Celiac disease is secondary develop multivitamin failure, hypoproteinemia, susceptibility to infections. If the child is ill for a long time, developing osteoporosis, reorganization of structure of bone deformations and sometimes fractures, dental caries, tetany in the form of Kerio-foot spasm (hypocalcemia), stunting, which indicates the severity and duration of disease. The level of calcium and phosphorus in the blood is reduced. Reduced serum alkaline phosphatase, also lowered blood levels of cholesterol and lipids. Low blood sugar, flat sugar curve. Sometimes due to lack of iron absorption is much hypochromic anemia.
In contrast to the cystic fibrosis, celiac disease exocrine activity of the pancreas does not change significantly. In cystic fibrosis, there is complete absence or a sharp decline in the selection of individual enzymes, especially trypsin; celiac disease is usually only a temporary decrease of activity of enzymes in flare-UPS. Outside during the exacerbation of the activity of the pancreas normal.
Differential diagnosis. First of all it is necessary to exclude the cystic fibrosis, and anatomic abnormalities of the gastrointestinal tract, chronic intestinal infections, tuberculosis, intestinal and mesenteric nodes.
The forecast. Due to improvements in diet and treatment methods, which should be carried out constantly, mortality from celiac disease is practically zero.
Treatment. High-calorie restricted diet fat and starch, but with enough protein, vegetables, fruits. Caloric intake of the patient celiac disease should be 2 times more than is healthy. Excluded wheat and rye products (noodles, bakery products, cereals, wheat starch). Well transferred potato, soybean and corn flour, rice, glucose, honey, fruit, vegetables, dairy products, especially acidic, low-fat cottage cheese. Vegetable fats are digested better than animals. Good effect is added to the food amino acids. Assigned vitamins (A, D, C, complex). In severe cases, vitamins, as a fat-soluble or insoluble, it is better to enter parenteral. Shows the use of iron, calcium, as well as stimulating therapy, blood transfusion, plasma. Was held attempts of application of corticosteroid hormones, but their efficacy is insufficiently proved. There is an indication that the use of hormones in celiac disease improves the absorption of iron from the effects of steroids on the cells of the intestine [Badenoch and Callender (S. Badenoch, S. Kallender)].