La celiac disease is a chronic, autoimmune and systemic disease that in Italy it concerns 233,147 people. At least another 400,000, however, are awaiting a diagnosis. It is increasingly difficult to identify it, so much so that often patients not yet diagnosed suffer from problems not immediately attributable to celiac disease e it can take years before you know you are celiac exposing yourself to serious complications. So how can you identify the disease?
The two factors
According to the experts AIC Italian Celiac Association: «Celiac disease is a complex, systemic and multifactorial disease. To develop celiac disease, in fact, they are necessary at least two factors: the genetic predisposition and the environmental factorthat is theexposure to gluten. Both factors, however, are necessary but not sufficient (only 3% of genetically predisposed subjects who take gluten manifest the disease) and, to date, the triggering events are not known with certainty which lead to the onset of the disease “.
Symptoms
Symptoms they are highly variable, both in severity and in the organs affected. In the children intestinal symptoms such as chronic diarrhea, vomiting, abdominal distensionas well as stunting, muscle weakness, anorexia and irritability. In the adults celiac disease occurs more often with extraintestinal symptomswhich can involve almost all organs, even in the absence of classic intestinal symptoms: short stature, anemia, tooth enamel hypoplasia, diabetes mellitus, autoimmune thyroiditis, alopecia, epilepsy and, in women, irregularities in the menstrual cycle, infertility, repeated miscarriages, osteoporosis.
Herpetiform dermatitis
There is one peculiar and distinct form of celiac disease: this is the herpetiform dermatitisa chronic, itchy, polymorphic dermatitis, induced by gluten, frequently undiagnosed for years in the patient. This results in a delay in adopting the only therapy known today for this pathology, or of a gluten-free dietresulting in worsening of intestinal involvement and an increased risk of life-threatening complications.
The diagnosis
Start from general practitioner and pediatricianis done with blood test for specific antibodies and biopsy of the small intestine, performed while the diet still includes gluten. The different symptoms often cause a delay in the diagnosis, to the point of having made it one of the most under-diagnosed diseasesso it can take years before a person knows he is celiac and, therefore, can adopt the only therapy known today for this pathology: the gluten-free diet.
Celiac disease: diagnosis in decline
“From the Annual report to Parliament on celiac diseasewe know that diagnoses have grown at a reduced rate in recent years: from + 35% in 2009 to + 3.4% in 2020too little for a disease that about 400,000 patients do not yet know they have, ”he explains Giuseppe Di FabioPresident of AIC, and continues: «we have worked on a program that can deliver the valuable information contained in the recommendations to general practitioners and specialistsinvolving the scientific communities of reference to reach specialist doctors through their communication and updating channels ».
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