Definition
L ‘ intolerance to gluten is a paraphysiological endurance of altered intestinal condition towards a nutritious protein, called gluten .
In Italy, permanent gluten intolerance is known as celiac disease or celiac disease, while in English it is labeled with many other names, such as: c (o) eliac sprue , c (o) eliac disease, nontropical sprue , endemic sprue and gluten enteropathy .
The term “celiac disease” or “c (o) eliac” derives from the Greek ” koiliakos κοιλιακός ?? ”, Which means“ abdominal ”; this term was introduced in 1800 to translate an ancient Greek description of the so-called “Areteo of Cappadocia” disease.
Gluten intolerance is not allergy
Gluten intolerance is NOT an allergy, neither to gluten, nor to other wheat proteins or similar.
If it is true that it involves the intervention of the immune system (like allergies), it is also true that celiac disease does it in a totally different way from allergic forms . Gluten intolerance causes a complication localized in the mucous membrane of the intestine and, only later, leaves some traces on the blood type parameters. However, even in the most important cases, the implication of allergy specific antibodies ( IgE ) is missing and there is no risk of anaphylaxis .
More than a disease, gluten intolerance is preferably defined as a paraphysiological condition, since, in the absence of exposure to the specific agent (gluten), the organism remains calmly in homeostasis as if it were healthy. Otherwise, a pathological picture of extremely variable severity and symptomatology can arise.
Pathological Mechanism
As anticipated, gluten intolerance is caused by an adverse reaction to gluten, or rather to gliadin . In fact, from a chemical point of view, gluten is a peptide complex formed by two proteins , called gliadin and glutenin , which combine only in the presence of water .
Gliadin is a prolamine present in some cereals (botanically: Poaceae or Gramineae family ) belonging to the Triticeae Tribe ; to be clear, the major exponents of this group are: durum and soft wheat , small spelled , medium andspelled , kamut etc. The seeds of some plants of the Hordeae tribe , such as barley and rye , as well as of the Aveneae tribe , such as oats also contain gliadin . The latter, however, is tolerated by some celiac subjects.
Going further into the specifics of gliadin, the elements that encourage intolerance are three peptides. Precisely on these, the tissue transglutaminase enzyme brings about a structural change that triggers the reaction of the immune system. The defense mechanism, unnecessarily alerted, carries out a cross-reaction and inflames the target tissue (which we remember to be the mucosa of thesmall intestine ).
The excessive and useless reaction of the immune system causes edema and shortening of the intestinal villi that line the mucosa (a phenomenon called villous atrophy). As these are the structures responsible for the absorption of food nutrients, their annihilation reduces the entry of many nutritional substances, including the so-called essential ones.
Gluten intolerance can easily cause some vitamin deficiencies , due to the reduced absorption capacity of the small intestine.
Onset, Symptoms, Clinical Signs
Gluten intolerance occurs in genetically predisposed people of all ages , with onset usually localized from mid-childhood onwards.
The “typical” symptoms of gluten intolerance are: pain and discomfort of the digestive tract, chronic constipation or diarrhea (sometimes alternating, thus simulating an irritable bowel syndrome ), growth failure in children , anemia (apparently unjustified and which does not respond to martial food supplementation ) and fatigue.
In some less frequent cases, the typical symptoms of celiac disease may be absent or marginal; on the other hand, atypical manifestations prevail, referring to other organs / areas of the organism (a peculiarity that often makes diagnosis very difficult). It is possible to learn more about the alternative manifestations of celiac disease by reading: Celiac Disease: The Atypical Symptoms .
Sometimes, it is even possible for the exact opposite to happen; that is, a series of “typical” symptoms associated with the consumption of gluten-containing foods, however, in the absence of the diagnostic criteria for intolerance. It should be remembered that, according to some, these eventualities largely depend on: psychosomatic (autosuggestion) and other reasons completely independent of gluten itself. On the other hand, it seems that the diagnosis of this discomfort is constantly increasing, which requires not to underestimate it.
For more information, see the Non-Celiac Gluten Sensitivity article .
Diagnosis
In addition to detecting or not typical and / or atypical clinical symptoms and signs, some tests must be carried out for the diagnostic confirmation of gluten intolerance.
There are various types, more or less invasive and more or less precise. Among these, the safest is intestinal biopsy: even if quite invasive, it has the advantage of allowing an assessment of the severity of the functional and histological impairment. Follow the dosages of certain blood parameters , such as the detection of antibodies: antiendomysium , anti gliadin IgA, anti gliadin IgG and antitransglutaminase .
If initially the diagnosis of gluten intolerance was made almost exclusively on people who suffered from gastrointestinal disorders, thanks to increasingly effective screening methods , today the cases of asymptomatic celiac disease or with atypical symptoms are rapidly increasing . Globally, gluten intolerance affects about one in 100-170 people; however, the results vary by region of the world, from very poor like 1: 300 to very frequent like 1:40.
For more information on the diagnosis of gluten intolerance, I suggest reading the article Tests for the diagnosis of Celiac disease .
Prevention and Treatment
The only treatment (both preventive and curative) really effective against the complications induced by celiac disease is that of the gluten-free diet or diet for celiac disease ; wanting to broaden the topic, please refer to the articles: Drugs to cure Celiac disease , Celiac disease: nutrition, advice, therapy and Gluten-free foods.
