Celiac Disease
Celiac, a common chronic autoimmune intestinal disease, is attributed to the immune system’s reaction to gluten - a protein found in various grains, such as wheat, barley, rye and oats. For people with Celiac, the immune system, which is designed to protect the body from infection, identifies gluten as a foreign body and produces antibodies to attack it. As a result, the lining of the small intestine becomes inflamed, preventing the body from absorbing essential nutrients such as Vitamin D and folic acid, and if not diagnosed on time and treated, the body may suffer from nutritional deficiencies and health problems such as iron-deficiency anemia, increased fatigue and osteoporosis.
In the past, it used to be thought that Celiac disease was only detected in childhood, but over the years it became clear that more than a few cases have been diagnosed at an old age, even after the age of 60.
Prevalence of the disease
Celiac disease is common in Israel as well as in many countries around the world, affecting an estimated 0.5%-1% of the population. There are countries in which prevalence is even higher, affecting an estimated 2.5% of the population.
Factors
Disease onset is essentially the end of a process that involves genetic and environmental factors. The main cause behind the occurrence of the disease is a genetic disposition to Celiac. Most patients are carriers of the 2HLA-DQ or 8HLA-DQ genes, but it is important to know that not all carriers will develop the disease. The percentage of Celiac carriers in Israel is 30%–40% of the population.
The main cause behind the occurrence of the disease is hereditary that, along with prolonged exposure to gluten and its products found in wheat, barley, and rye products, activates the immune system to a trigger an autoimmune reaction (that is, the body’s immune system attacks itself). This response primarily affects the lining of the small intestine, impeding its ability to properly absorb and transfer food components to the blood. As a result, various symptoms may appear.
Symptoms
Symptoms of the disease are wide and varied, with most associated with the digestive system, while different symptoms can appear in different patients, some more common and some less so. In addition, there are cases of the disease being detected in a laboratory without any symptoms at all.
When discussing children, symptoms primarily involve gastrointestinal problems, such as stomach aches, constipation and diarrhea, and growth problems.
Risk groups
Celiac disease , with its genetic component, places first-degree relatives of a patient at higher risk of getting sick.
Furthermore, the risk of Celiac disease increases in children who have another autoimmune disease, such as juvenile diabetes, or with a genetic syndrome, such as Down syndrome.
Diagnosis
If Celiac is suspected, largely due to the onset of symptoms, you will be asked to have your child undergo blood tests to detect TTG and EMA antibodies, which may indicate the presence of the disease. Occasionally, to confirm the findings of the blood test, you will be asked to undergo a biopsy during the gastroscopy. During the test, once the child has been sedated, a tube is inserted through the esophagus and stomach to the top of the small intestine, where a sample of cells will be collected to be sent to the laboratory for testing. To confirm the diagnosis of the disease, the sample will be searched for mutations typical of the disease in the collected cells.
Important to know
Important to know
In a desire to avoid invasive tests in children, the current guideline recommends avoiding a biopsy when diagnosing most children. Initially, blood tests will be performed, and if any of the results are abnormal, another blood test will be carried out. If both tests are positive, a diagnosis of Celiac disease can be established. If the results of the blood tests are inconclusive, a biopsy may need to be performed.
The importance of early detection
Early detection of Celiac is critical to the normal health and development of children, in addition to preventing various health complications, such as growth disorders, delayed sexual maturation and development of various autoimmune diseases.
If Celiac is suspected, you should contact the pediatrician for further clarification. If necessary, you will receive a referral for continued Gastroenterology examination.
Additionally, if the child is diagnosed with Celiac, the other family members should also be tested. One of the parents is frequently found to be sick without knowing it.
Treatment
Celiac is a chronic and life-long disease for the patient. The only way to treat the disease is prevention - that is, avoiding exposure to gluten and adhering to a gluten-free diet. Maintaining a proper diet will help the intestine recover within several weeks and rehabilitate within several months while lowering teh risk of developing cancer later in life.
Recommended diet
Celiac patients are advised to adhere to a diet free of gluten, which is found in wheat, rye, barley and occasionally oats. Food containing over 20PPM of gluten must not be eaten as they can cause intestinal damage (since 1996, Israel has required food containing gluten to be marked).
Today, there is a large supply of gluten-free food such as bread, rolls, pasta and corn flakes that are found in large supermarket chains and health food stores.
Important to know
Important to know
HMOs offer Celiac patients who need dietary treatment consulting and supervisory services with diet experts.
Impact of the disease on the family
A gluten-free diet is vital for Celiac patients, since eating gluten may significantly damage the small intestine. It is therefore critical to change eating habits. Today, it is not difficult to obtain gluten-free products. Every large supermarket has a special area dedicated to gluten-free products. The main disadvantage may be the price of the food, which is, in most cases, much higher.
Many families that have a member with Celiac Disease choose, for reasons of safety and convenience, to make a dietary change and adopt a gluten-free diet for the entire family.
Celiac patients may also expect to encounter more than a few social challenges attributed to the need for a special diet in various frameworks from the education system (birthdays, trips, etc.) to military service. At the same time, social awareness of the issue is greater, as is cooperation on the part of various parties.
It should be remembered that the disease has psychological repercussions, and it is therefore important to help children cope with the diagnosis of and living with the disease. No child wants to feel different. Young children in particular may experience frustration and anger in light of the the concessions they have to make.
There are several ways parents can use to help their child with Celiac cope:
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Provide information and involve
It is important to teach them about the disease, to understand the new family dynamic and to involve all of the children in the family about the expected change. Knowledge and involvement provide a sense of control over the situation.
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Support, reinforce and empower
A significant part of coping with a chronic disease is emotional support, encouragement and family embrace. It is critical to empower the child and to positively reinforce coping and restraint when faced with prohibited food, to provide good gluten-free alternatives, to involve them in shopping for suitable food and in meal preparations.
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Moderate disease in the external environment
Proactively provide explanations in the preschool or classroom. Such an experience can improve self-confidence, give a feeling of uniqueness and not of abnormality, and teach other children in the educational framework how they can help and protect friends who suffer from a disability.
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Seek professional therapy if necessary
When facing difficulty in coping with the disease, professional assistance in the relevant area is recommended, such as dietary consultation or psychological therapy, in addition to continual monitoring based on guidelines that were received.
Patient Rights
There are several rights and benefits to which Celiac patients are entitled. These are the relevant rights for children:
- Celiac patients and patients who need drug therapy (regardless of Celiac disease) are entitled to receive treatment that suits them in terms of ingredients, even if it is not included in the health services basket.
- As part of any educational activity that includes materials or food with gluten, the various educational institutions in Israel are obligated to provide suitable substitutes for students with Celiac disease.
- Educational institutions where food is provided or sold must also offer gluten-free options.
- Food packaging intended for students with Celiac disease must be marked or highlighted with color.