Take 10 Questions About Celiac Disease
1. Gastroenterologist Vera Lucia Sdepanian, coordinator of the celiac outpatient clinic of the Paulista School of Medicine of Unifesp, says that after starting a gluten-free diet, the intestinal mucosa recovers in how long?
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, if the gluten is totally excluded from the diet, the intestine takes from six months to a year to return to normal. "However, we did a survey and found that about 30% of coeliacs do not properly follow the restrictive diet," says the Unifesp gastroenterologist. These slips may further delay the recovery time of the mucosa.
2. Celiac disease brings complications to the gut only?
No, according to gastroenterologist Vera Lucia, a person who has the disease and does not follow the restriction to gluten may have greater risks of developing several problems: osteoporosis, anemia, infertility, cancer (both in the gut and in other parts of the body, such as the lymphatic system), among others.
To avoid these problems, the gastroenterologist Eduardo Berger, of the Hospital Complex Edmundo Vasconcelos, recommends having a lot of discipline in food. "The complications are very serious and all of them related to malnutrition, but they only occur in patients who do not dedicate themselves to the gluten-free diet," he says. Is it true that some medicines can have gluten?
Yes, although they are few. "The patient will only have problems when the medicine has gluten in the excipient of the capsule (material that gives mass to the medicine), but today this ingredient is little used," says gastroenterologist Celso Mirra. It is important to keep an eye on the labels, as the pharmaceutical industry is obliged by law to report on the packaging the presence of gluten
4. How often do you have to have an examination to check your bowel health?
Once a year, at least. "You need to consult your doctor, perform routine laboratory tests and specific blood tests for celiac disease," says gastroenterologist Celso Mirra. Endoscopy and duodenal biopsy are examinations made when the clinical picture of the disease normalizes, usually after two years.
5. Why is intestinal mucosa impaired?
Eduardo Berger says that the patient with celiac disease has immunity incompatible with a protein present in gluten called gliadin. "When this protein is ingested, an enzyme located in the mucosa of the intestine called transglutaminase acts against it, causing an immune response, that is, the body itself forms a harmful substance, an autoantibody, which atrophies the intestinal mucosa," he explains. > 6. Is it possible to have celiac disease without manifesting symptoms?
There are cases in which the symptoms can be very mild and the patient hardly suspects that he is carrying the disease. "The diagnosis happens with a more rigorous observation of the few signs presented, such as gas, irregularity, even if discreet, of intestinal habit and weight loss not significant," says the gastroenterologist Eduardo. When suspected, the physician should also look for specific autoantibodies of the disease from a blood test.7. Some people can manifest the disease only in adulthood?
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Yes, although it appears more in children, the disease can affect any age. According to Eduardo Berger, the reason some people only discover in adulthood may be the presence of few symptoms for years. "This makes the diagnosis often only done in adulthood, increasing the risk of complications," he says.
8. In addition to the gluten restriction, do you need supplementation?
In some cases, yes. Supplementation is often necessary when the patient takes too long to discover the disease or does not strictly follow a gluten-free diet. In these two cases, the intestinal mucosa will be so atrophied that it will have difficulty absorbing nutrients. "The patient may not be able to absorb mainly vitamins B9 (folic acid), B12, D, K and the minerals calcium and iron," says Celso Mirra.
The lack of these nutrients can lead to anemia, osteoporosis, blood clotting, among other problems. "Supplementation, however, must always be done with medical or nutritional monitoring," says Eduardo Berger.
9. Is celiac disease hereditary?
Yes. Vera Lucia Sdepanian explains that to manifest intolerance to gluten, you must have a genetic predisposition. "If this does not happen, there is little chance of developing the disease and with a small intensity," says the gastroenterologist. "The proportion found in studies is that 6% of the first-degree relatives of a person with the disease also have intolerance."
10. Even a minimal amount of gluten can trigger complications?
Depending on the intensity of the disease, yes. "There are people with celiac disease who, if they use the same knife someone used to make jelly on wheat bread, for example, they may have diarrhea," says nutrologist Andrea Bottoni, coordinator of the nutrology team at Villa Lobos Hospital. Therefore, it is essential to take care to avoid any gluten intake.
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