Celiac disease (celiac disease): symptoms

Symptoms of celiac disease are very variable. In severe disease, when the entire small intestine is involved in the pathological process, a pronounced non-treatable, often incompatible with life syndrome of total impairment of absorption develops, in which secondary damage to many organs and systems often occurs. There are also intestinal signs of the disease (profuse diarrhea, polyphecal, etc.). In contrast, patients with limited lesions, including only the duodenum and proximal lean, may not have gastrointestinal symptoms. They are only possible anemia, due to deficiency of iron and / or folic acid, vitamin B12, as well as signs of demineralization of bones.

The natural course of untreated gluten enteropathy is characterized by alternation of periods of exacerbation and remission. The disease can occur in infancy, when they start to give products containing gluten. If treatment is not started, the symptoms are observed throughout the entire period of childhood, but in the period of adolescence they often decrease or completely disappear. In 30-40 years, signs of the disease usually resume.

In a number of patients, the manifestations of the disease are virtually absent, and the diagnosis is difficult before reaching the average or even the elderly. The possibility in adults of asymptomatic flow of gluten enteropathy 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 disease. With a significant bowel injury, frequent (up to 10 or more times per day) and abundant stools - watery or semi-formal, light brown. Quite often feces are foamy or ointment (contains a large amount of undigested fat) with a fetid odor.
2. Flatulence. Often observed with gluten eroshropathy and manifested sensations of bloating, raspiraniya in the abdomen, difficulty breathing. The flatulence is accompanied by the precipitation of a large amount of fetid gases. In many patients, flatulence does not decrease even after defecation.

Symptoms due to the development of malabsorption syndrome

• Losing weight. Weight loss is all the more pronounced, the larger and heavier the lesion of the small intestine and the severity of mucosal atrophy. The muscles of the patients are atrophic, the muscle strength is significantly reduced. The skin is dry, the turgor and its elasticity are sharply reduced. Fingers resemble "drumsticks", nails - "watch glass". The fall of body weight is accompanied by a pronounced weakness, rapid fatigue.
• The delay in growth and physical development in children. With the development of clinical symptoms in early childhood, there is a marked lag in children's growth, physical and sexual development.
• Violation of protein metabolism. Violation of the splitting and absorption of proteins in the intestine leads to significant disturbances in protein metabolism, which is manifested by weight loss, muscle atrophy, a decrease in the total protein and albumin content in the blood. With severe hypoproteinemia, there may be hypoproteinemic edema, sometimes markedly.
• Violation of lipid metabolism. Violation of the absorption of fat leads to a decrease in the content of cholesterol, triglycerides, lipoproteins in the blood and is manifested by weight loss, disappearance of subcutaneous fat, the appearance of steatorrhea.
• Violation of carbohydrate metabolism. Violation of the splitting and absorption of carbohydrates is manifested by a tendency to decrease the glucose level in the blood; sometimes hypoglycemia has clinical manifestations: sweating, palpitation, headache, hunger.
• Violation of calcium metabolism. The disorder of calcium absorption in the small intestine, accompanied simultaneously by a violation of absorption of vitamin D, leads to significant disturbances in the metabolism of calcium and the osteoarticular system. In patients, the calcium content in the blood decreases, its entry into the bone tissue is broken, osteoporosis develops (its development is promoted by the hyperfunction of parathyroid glands in response to hypocalcemia). Clinically, these changes are manifested by pains in the bones, especially in the lumbar spine, thorax, pelvic bones, pathological (ie, arising without injury) bone fractures. With severe hypocalcemia, there may be seizures, which is promoted by the often observed deficiency of magnesium.
• 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} impaired _, which is manifested by the clinic В _12- deficiency anemia. Possible development of a multifactorial anemia, caused by a simultaneous deficiency of vitamin B ₁₂ and iron.
• N collapse of the endocrine glands. Endocrine dysfunctions develop in severe gluten enteropathy and a pronounced malabsorption syndrome. Insufficiency of the adrenal cortex is manifested by severe weakness, pigmentation of the skin and mucous membrane (the skin acquires a grayish-brown, light brown or bronze shade), arterial hypotension and dizziness, lowering of sodium, chlorine, cortisol in the blood.

Dysfunction of the sexual glands is manifested in men by a decrease in potency, a decrease in the severity of secondary sexual characteristics, atrophy of the testicles; in women hypo- or amenorrhea.

Perhaps the development of hypothyroidism in connection with a violation of absorption in the intestine of iodine. Insufficient function of the thyroid gland is manifested by the pastosity of the face, increased body weight, chilliness, bradycardia, constipation, hoarseness, drowsiness, memory loss, hair loss, dry skin, decreased blood T ₃, T ₄. In rare cases, the development of autoimmune diabetes is possible.

• Polyhypovitaminosis. Violation of absorption of vitamins leads to the development of symptoms of hypovitaminosis. Lack of vitamin A is manifested by dry skin, decreased visual acuity (especially in twilight); lack of vitamin B ₁₂ - macrocytic anemia; vitamin C - increased bleeding, skin hemorrhages, bleeding gums, pronounced general weakness. Deficiency of vitamin B leads to the development of peripheral polyneuropathy (reduction of tendon reflexes, sensitivity in the distal parts of the limbs), sensation of paresthesia, numbness of the legs). The defeat of 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.
• The defeat of other organs of the digestive system. When examining the oral cavity, glossitis is noted (tongue crimson-red, cracked, papillae smoothened), lips dry, cracked. The abdomen is swollen, enlarged in volume (due to flatulence), with the development of severe hypoproteinemia, the appearance of ascites may occur. In some patients, the liver is enlarged (a sign infrequent), with ultrasound its diffuse changes are determined.
• Defeat of the myocardium. In patients with gluten enteropathy, myocardial dystrophy develops, which is characterized by the appearance of dyspnea and palpitations, especially with physical exertion, a slight extension of the left border of the heart, deafness of the heart tones, a decrease in the T wave on the ECG.

Clinical forms of gluten enteropathy (celiac disease):

Depending on the characteristics of the clinical course, distinguish:

• typical form - characterized by typical symptoms and development of the disease in early childhood;
• erased form - is characterized by the predominance in the clinical picture of extraintestinal manifestations (anemia, osteoporosis, etc.).
• latent form - characterized by a low severity of clinical manifestations, subclinical flow and is first manifested in adults or even in old age.

[1], [2], [3], [4], [5], [6], [7], [8], [9]