Celiac disease (Celiac Enteropathy, European Sprue, Nontropical Sprue, Idiopathic Sterea Thorea)

A rare disease (fermentopathy) of the intestine, characterized by atrophy of the mucous membrane of the small intestine in response to the introduction of gluten - a polypeptide contained in some cereals (wheat, rye, barley, oats).

Etiology, pathogenesis. The disease is caused by the congenital absence or reduced production of enzymes by the intestinal wall that break down gluten. The absence (or relative insufficiency) of the production of this peptidase is especially evident in case of nutritional disorders, the predominance of cereals containing gluten in the diet, intestinal infections, and during pregnancy. Products of incomplete digestion of gluten (gliadin, etc.) have a toxic effect on the intestinal wall and stimulate the development of autoimmune reactions, causing atrophy of the small intestinal mucosa and the development of malabsorption syndrome.

Symptoms, course. In the vast majority of cases, the first symptoms appear in childhood. Characterized by frequent (up to 10 times a day) mushy stools with a grayish tint after eating foods made from wheat, rye and barley, an enlarged abdomen due to a decrease in intestinal tone, and a decrease in body weight.

In advanced cases, chronic enteritis develops with malabsorption syndrome, protein-free edema, osteoporosis, iron deficiency anemia, polyhypovitaminosis, electrolyte imbalance, etc. Dysbiosis may develop. In children, if untreated, there is a delay in psychomotor development.

A scatological examination reveals steatorrhea, endoscopy reveals transverse striations of the folds of the small intestine, and histological examination reveals signs of its atrophy. Known assistance in differential diagnosis can be provided by the identification of antibodies to gluten, the presence of signs of the disease from early childhood, exacerbation of symptoms of the disease with a significant addition to the diet of products from wheat, rye, barley, oats, as well as the reverse development of symptoms of the disease when the patient is transferred to a gluten-free diet (gluten is absent in all animal products, corn, rice, soybeans, potatoes, vegetables, fruits, berries and other products).

Treatment: lifelong adherence to a gluten-free diet (exclusion from the diet of bread, confectionery, pasta, sausages, sausages and other products containing grains). If a gluten-free diet is ineffective for 3 months, or if the disease is severe (the appearance of protein-free edema), glucocorticoids are used (prednisolone 20 mg per day for 7 days). With the development of dysbiosis, therapy is carried out with antimicrobial agents (furazalidone, intetrix, etc.), then with bacterial drugs (bifidumbacterin, bificol, etc.). According to indications, multienzyme preparations (Creon, pancitrate, festal, etc.) are used. To reduce intestinal hypersecretion, astringent, enveloping, and adsorbent substances are used. According to indications, replacement therapy for protein and vitamin deficiency, correction of water and electrolyte metabolism disorders is carried out.