Celiac disease (gluten enteropathy) - Symptoms

Symptoms of celiac disease vary greatly. In severe cases of the disease, when the entire small intestine is involved in the pathological process, a severe, intractable, and often life-threatening syndrome of total malabsorption develops, which often results in secondary damage to many organs and systems. Intestinal signs of the disease are also observed (profuse diarrhea, polyfecalia, etc.). In contrast, patients with limited damage, including only the duodenum and proximal jejunum, may not have gastrointestinal symptoms. They may only have anemia due to iron and/or folic acid deficiency, vitamin B12, as well as signs of bone demineralization.

The natural course of untreated celiac disease is characterized by alternating periods of exacerbation and remission. The disease can occur in infancy, when gluten-containing products are introduced. If treatment is not started, symptoms are observed throughout childhood, but often decrease or disappear completely during adolescence. At 30-40 years of age, signs of the disease usually recur.

In a number of patients, the manifestations of the disease are virtually absent, and diagnosis is difficult until middle or even old age. The possibility of asymptomatic course of gluten enteropathy in adults is confirmed by morphological studies of biopsy and surgical material obtained from patients and their relatives.

The most characteristic symptoms of celiac disease are the following.

1. Diarrhea. The most common symptom of gluten enteropathy, especially in severe cases of the disease. With significant intestinal damage, frequent (up to 10 or more times a day) and abundant stools are observed - watery or semi-formed, light brown. Quite often, the stool is foamy or greasy (containing a large amount of undigested fat) with a foul odor.
2. Flatulence. Often observed in gluten eshropathy and manifested by a feeling of bloating, distension in the abdomen, difficulty breathing. Flatulence is accompanied by the release of a large amount of foul-smelling gases. In many patients, flatulence does not decrease even after defecation.

Symptoms caused by the development of malabsorption syndrome

• Weight loss. The more extensive and severe the damage to the small intestine and the severity of the mucous membrane atrophy, the more pronounced the loss of body weight. The muscles of patients are atrophic, muscle strength is significantly reduced. The skin is dry, its turgor and elasticity are sharply reduced. The fingers resemble "drumsticks", the nails - "watch glasses". The loss of body weight is accompanied by pronounced weakness, rapid fatigue.
• Delayed growth and physical development in children. When clinical symptoms develop in early childhood, children are significantly delayed in growth, physical and sexual development.
• Protein metabolism disorder. Disruption of protein breakdown and absorption in the intestine leads to significant protein metabolism disorders, which manifests itself in weight loss, muscle atrophy, and decreased blood levels of total protein and albumin. With severe hypoproteinemia, hypoproteinemic edema may occur, sometimes significantly so.
• Lipid metabolism disorder. Impaired fat absorption leads to a decrease in the blood cholesterol, triglycerides, lipoproteins and is manifested by weight loss, disappearance of subcutaneous fat, and the appearance of steatorrhea.
• Disruption of carbohydrate metabolism. Disruption of the breakdown and absorption of carbohydrates is manifested by a tendency to decrease the glucose content in the blood; sometimes hypoglycemia has clinical manifestations: sweating, palpitations, headache, feeling of hunger.
• Calcium metabolism disorder. Disorder of calcium absorption in the small intestine, accompanied by a simultaneous disorder of vitamin D absorption, leads to significant disorders of calcium metabolism and the musculoskeletal system. Patients have a decreased calcium content in the blood, its entry into bone tissue is disrupted, osteoporosis develops (its development is facilitated by hyperfunction of the parathyroid glands in response to hypocalcemia). Clinically, these changes are manifested by pain in the bones, especially in the lumbar spine, chest, pelvic bones, and pathological (i.e., occurring without trauma) bone fractures are possible. With severe hypocalcemia, convulsions may occur, which is often facilitated by the magnesium deficiency observed.
• Anemia. The development of anemia is caused by a violation of iron absorption in the intestine, a decrease in its content in the blood (iron deficiency anemia). Along with this, the absorption of vitamin B _{12 is disrupted,} which is manifested by the clinical picture of B ₁₂ -deficiency anemia. The development of polyfactorial anemia is possible, caused by a simultaneous deficiency of vitamin B ₁₂ and iron.
• Disruption of endocrine gland function. Endocrine dysfunctions develop in severe cases of gluten enteropathy and severe malabsorption syndrome. Adrenal cortex insufficiency is manifested by severe weakness, pigmentation of the skin and mucous membrane (the skin becomes grayish-brown, light-brown or bronze), arterial hypotension and dizziness, decreased levels of sodium, chlorine, and cortisol in the blood.

Dysfunction of the sex glands manifests itself in men as decreased potency, decreased expression of secondary sexual characteristics, testicular atrophy; in women - as hypo- or amenorrhea.

Hypothyroidism may develop due to impaired absorption of iodine in the intestine. Insufficient thyroid function is manifested by facial puffiness, weight gain, chilliness, bradycardia, constipation, hoarseness, drowsiness, memory loss, hair loss, dry skin, decreased T3, T4 levels in the blood _. In _rare cases, autoimmune diabetes may develop.

• Polyhypovitaminosis. Impaired absorption of vitamins leads to the development of hypovitaminosis symptoms. Vitamin A deficiency manifests itself as dry skin, decreased visual acuity (especially at dusk); vitamin B ₁₂ deficiency - macrocytic anemia; vitamin C - increased bleeding, skin hemorrhages, bleeding gums, severe general weakness. Vitamin B deficiency leads to the development of peripheral polyneuropathy (decreased tendon reflexes, sensitivity in the distal extremities), a feeling of paresthesia, numbness in the legs). Damage to the nervous system is aggravated by a deficiency of vitamins B ₆, B ₁₂, B _2, PP. With a deficiency of vitamin B ₂, angular stomatitis develops, vitamin K - hypoprothrombinemia.
• Damage to other organs of the digestive system. When examining the oral cavity, glossitis is noted (the tongue is raspberry-red, cracked, the papillae are smoothed out), the lips are dry, cracked. The abdomen is swollen, increased in volume (due to flatulence), with the development of severe hypoproteinemia, ascites may appear. In some patients, the liver is enlarged (an infrequent sign), with ultrasound, its diffuse changes are determined.
• Myocardial damage. Patients with gluten enteropathy develop myocardial dystrophy, which is characterized by shortness of breath and palpitations, especially during physical exertion, slight expansion of the left border of the heart, muffled heart sounds, and a decrease in the T wave on the ECG.

Clinical forms of gluten enteropathy (celiac disease):

Depending on the characteristics of the clinical course, a distinction is made between:

• typical form - characterized by typical symptoms and development of the disease in early childhood;
• latent form - characterized by the predominance of extraintestinal manifestations (anemia, osteoporosis, etc.) in the clinical picture.
• latent form - characterized by mild clinical manifestations, subclinical course and first appears in adults or even in old age.

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