We talk a lot about gluten, because 600,000 French people can only indulge in the pleasures of the table after a real police investigation to track it down. Otherwise, watch out for the digestive effects of celiac disease. But you still have to be aware that you are sick!
What is there in breads, pastries, pasta, semolina, cheese spreads, cold cuts, and certain gel creams, which are not found in dairy products, ham, fish or the fruits? Well, it’s gluten, a protein that would never have been talked about if some people weren’t totally intolerant of it.
What frequency?
This intolerance affects one in 100 people in our country. So six hundred thousand people who constantly have to ask themselves whether the foods they are offered do not contain a fraction of this terrible protein. Remember that if we assimilate our body to a wall, proteins are its building blocks.
How does it translate?
The first troubles usually occur in the weeks following the introduction of the flour to the infant. The weight curve is stagnant, even falling. The infant is grumpy even though he has a good appetite, even always hungry. His stools are large. And it is especially these chronic diarrhea that alert the doctor.
In children, the symptoms of celiac disease can vary widely. There may be digestive disturbances, such as chronic or intermittent diarrhea, nausea and vomiting, and / or lack of appetite. Sometimes the child also suffers from recurrent abdominal pain or bloating due to a buildup of intestinal gas. We can also observe non-digestive signs such as weight loss and / or growth retardation, chronic fatigue, iron deficiency anemia, delay in the onset of puberty.
Sometimes, however, the diagnosis can be made much later, in adults, with chronic diarrhea, which is the most common symptom, but also constipation. Some adults experience abdominal pain or bloating, associated with gas and weight loss. There are many non-digestive signs. There may thus be chronic fatigue, anemia due to iron, vitamin B9 or folic acid deficiency, recurrent mouth ulcers or osteoporosis in young women.
How to diagnose it?
A simple blood test looking for signs of specific allergies to gluten, antibodies, confirmed by an endoscopy, will make it possible to put a name on the symptoms but unfortunately will make the gastronomic life of the patient rather painful until the end of his days.
Tissue immunoglobulin A (IgA) antitransglutaminase assay is the test of choice for celiac disease, and the suspicion should be confirmed by assaying for anti-endomysium antibodies and testing for HLA DQ2 / DQ8 typing. Intestinal fibroscopy with biopsies remains essential in adults.
Is fibroscopy essential?
A large European study on more than 800 children set out to confirm that endoscopy could be dispensed with for the diagnosis of gluten intolerance. This study was carried out in 21 countries and it looked at the threshold value of the level of specific antibodies in the blood which makes it possible to confirm the diagnosis of celiac disease with a probability equal to that of endoscopy.
In this beautiful study, it is confirmed that the presence of a tissue antitransglutaminase antibody at a level greater than 10 times the normal, associated with any of the usual clinical signs, has a predictive value close to 100. HLA typing does not not add much. The conclusion is that the positivity of this test, confirmed by a positive assay of an anti-endomysium antibody, would make it possible to avoid endoscopy in more than half of the children, this is less suffering and a source of savings in more.
What treatment?
Once the disease is diagnosed, the principle of treatment is based on a gluten-free diet. It could not be simpler in theory, but its implementation is not an easy task. For products purchased on the market, the theoretically obligatory composition must indicate this. But it becomes much more complicated when it comes to food prepared by a restaurant or, more serious, because it is the most frequent situation, in the canteen. This becomes almost impossible mission and imposes a kind of marginalization of the community. Anyone suffering from gluten intolerance must therefore be alerted at all times and engage in real police investigations. Because the call to order is almost immediate.
Is diet the only treatment?
Yes, it is the only treatment known today while waiting for the availability of a replacement enzyme, greedy enough to destroy gluten. This would allow the development of an effective drug, whereas today, the only contribution of the pharmacy is to offer a whole series of gluten-free foods unfortunately not very cheap.
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