Definition
Gluten intolerance is a paraphysiological condition of altered intestinal tolerance towards a protein nutrient, 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" comes from the Greek " koiliakos κοιλιακός‚ ", which means" abdominal "; this term was introduced in 1800 to translate an ancient Greek description of the so-called "Aretaeus of Cappadocia" disease.
Gluten Intolerance is not allergy
Gluten intolerance is NOT an allergy, neither to gluten, nor to other wheat proteins or the like.
If it is true that it implies the intervention of the immune system (such as allergies), it is true that celiac disease does so in a totally different way from the allergic forms. Gluten intolerance causes a localized complication in the mucous membrane of the intestine and, only later, leaves some traces on blood type parameters. However, even in the most important cases, the implication of antibodies specific for allergies (IgE) is missing and there is no risk of anaphylaxis.
More than a disease, gluten intolerance is preferably called a paraphysiological condition, since, in the absence of exposure to the specific agent (gluten), the organism remains quietly in homeostasis as if it were healthy. Otherwise, a pathological picture of extremely variable gravity and symptomatology can be established.
Pathological Mechanism
As anticipated, gluten intolerance is caused by an adverse reaction to gluten, or rather to gliadin . In fact, from the 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: family Poaceae or Gramineae ) belonging to the Tribe of Triticeae ; to be clear, the main exponents of this group are: durum and tender wheat, small spelled, medium and spelled, kamut etc. The seeds of some Hordeae Tribe plants, such as barley and rye, as well as the Tribea Aveneae, 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 stimulate intolerance are three peptides. Precisely on these, the tissue transglutaminase enzyme provides a structural modification 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 the small intestine).
The disproportionate and useless reaction of the immune system causes edema and shortening of the intestinal villi that cover the mucosa (a phenomenon called villous atrophy). Since 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 capacity of absorption 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 in the digestive tract, chronic constipation or diarrhea (sometimes alternating, thus simulating an irritable bowel syndrome), growth failure in children, anemia (apparently unjustified and that does not respond to martial food integration) and fatigue.
In certain less frequent cases, the typical symptoms of celiac disease may be absent or marginal; atypical manifestations prevail, referring to other organs / districts of the organism (a peculiarity that often makes diagnosis very difficult). It is possible to investigate the alternative manifestations of celiac disease by reading: Celiac disease: Atypical Symptoms.
Sometimes, it is also possible for the exact opposite to happen; or that there is a series of "typical" symptoms related to the consumption of foods containing gluten, but without the diagnostic criteria for intolerance. It must 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 article Gluten free non-celiac disease.
Diagnosis
In addition to the detection or not of the typical and / or atypical symptoms and clinical signs, some tests are necessary 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 the intestinal biopsy: even if quite invasive, it has the advantage of allowing an evaluation of the severity of functional and histological impairment. The dosages of certain blood parameters follow, such as the detection of antibodies: antiendomysium, anti-gliadin IgA, anti-gliadin IgG and anti-transglutaminase.
If initially the diagnosis of gluten intolerance was made almost exclusively on people suffering from gastrointestinal disorders, grazei to increasingly effective screening methods, today the cases of asymptomatic celiac disease or with atypical symptoms are suddenly increasing. Globally, gluten intolerance affects about one person in 100-170; however, the results vary according to the areas of the world, from very few as 1: 300 to very frequent as 1:40.
For more information on the diagnosis of gluten intolerance, I suggest reading the article Exams for the diagnosis of Celiac disease.
Prevention and Care
The only effective treatment (both preventive and curative) against the complications induced by celiac disease is that of the gluten-free diet or the celiac disease diet ; wanting to expand the topic, see the articles: Medications to treat Celiac disease, Celiac disease: nutrition, advice, therapy and gluten-free foods.
