Celiac disease

Celiac disease

Celiac disease represents one of the adverse bodily reactions to the intake of cereals (wheat, spelt, rye, barley, oats …).

The protein portion of these cereals, the gluten, may trigger an autoimmune reaction in genetically susceptible people. The resulting antibodies and the activated immune cells damage various parts of the body. Most often, the intestines are affected, which causes problems in food digestion ability. As a result, bloating, flatulence, diarrhoea, as well as abdominal pain may ensue. Due to an insufficient utilization of food, there may be weight loss, anaemia due to lack of iron, or osteoporosis.

Only fifteen years ago, celiac disease was considered to be a rare childhood disease, but now we know that it can affect adults equally often. Celiac disease is one of the most common chronic disorders in our environment – 0.5-1% of the population suffers from it. Since adult patients with celiac disease often present with atypical problems, the path to finding the right diagnosis can be longer.

The diagnosis of celiac disease is based on a particular blood test for specific antibodies. In the case that values are positive, the diagnosis must be confirmed with a gastroscopic biopsy of the duodenum or small intestine.

Celiac disease is treated with a strict gluten-free diet – the patients must not ingest even one crumb of plain bread or any other food containing gluten, or gluten in trace. These foods need to be replaced with special gluten-free products.

Basic information about the examination

Locations of celiac disease examinations

  • Bled | Pod skalo 4, 4260 Bled
  • Ljubljana | Barvarska steza 4 (Vila Urbana), 1000 Ljubljana
Appointment - referral Appointment - self pay

Targeted examination for celiac disease

Basic examination: 50 €

  1. With the nurse’s assistance tha patient fills out a brief questionnaire
  2. blood samples are taken for antibody tests (total IgA antibodies and anti-tissue transglutaminase antibodies (anti-tTG))
  3. after obtaining the lab findings, the doctor offers a brief opinion, e.g.:
    • Celiac disease is excluded with a significant (96%) probability.
    • Celiac disease is very likely, further testing is required as soon as possible.
    • The results are not clear. The doctor offers a suggested course of further procedures or advises a general health check at the clinic.

Warning: The basic examination DOES NOT ENTAIL CLINICAL EXAMINATION nor the review of other patient’s medical records, but only a doctor’s opinion on the basis of the obtained findings.

Extended health check: 125 €

The examination focus is the same as for the basic examination. Additionally, a HLA DQB1 genetic marker test is performed, on the basis of which we may, in certain cases, exclude the possibility of the presence or the subsequent development of celiac disease with high probability.

Genetic testing is particularly important for the relatives of patients with celiac disease, as well as for those who have already limited the amount of gluten in their diet, which makes the findings about the antibodies in their blood less reliable.

Control health check

By appointment, just for patients who have been already diagnosed with celiac disease and only wish an assessment of the current situation.

Diagnostic of celiac disease: 575 €

Do you often experience bloating, gas, diarrhoea or abdominal pain? Are you losing weight without an apparent cause and are anaemic (low blood iron levels)? Have you been diagnosed with osteoporosis? Is there a family history of celiac disease?

Then you are advised to undertake our examination package focusing on diagnosing celiac disease. In this way, you will be able to complete all the necessary tests in a single day, resulting in a reliable and definitive answer to your problems.

The celiac disease diagnostic examination package is composed of the following tests:

  • Specialist examination by an expert specialized in diagnosing celiac disease, including a final diagnosis and recommendations
  • Laboratory analyses – blood test, sedimentation, PTC, hepatogram, electrolytes, proteins, albumins, urea, creatinine, amylase, lipase, glucose, LDH, lipidogram, Fe, TIBC, TSH (thyroid score) Laboratory tests are used to examine the blood and carry out fundamental biochemical evaluations – liver, kidney, electrolytes, iron.
  • IgA tTG and IgA EMA antibodies
  • HLA DQB1 – determining genetic predispositions for the development of celiac disease.
  • Vitamin/mineral deficiency determination – ferritin, vitamin B12, folic acid, 25-OH vit D, zinc, magnesium.
  • Esophagogastroduodenoscopy – oesophagus, stomach and duodenum endoscopy.
  • Duodenum sample histological examination – laboratory test of tissue samples collected during the duodenum examination.

Frequently asked questions

About

When do we suspect celiac disease?

We suspect celiac disease in patients with vague indigestion problems, diarrhoea or increased urinary frequency, bloating and gases, or sometimes with atypical abdominal pain. We can also observe fatigue, oral ulcers, itchy blister rash on the skin (dermatitis herpetiformis), nervous system disorders, depression, etc.

Sometimes, the patients do not exhibit any particular problems, but celiac disease is still suspected, mainly due to related disorders; anaemia, or iron deficiency, is especially suggestive of celiac disease, and so are early osteoporosis, various autoimmune diseases, such as non-insulin-dependent diabetes mellitus of type 1, alopecia areata, vitiligo, various rheumatic disorders etc..

Among close relatives of those suffering from celiac disease, this disorder is up to 10 times more frequent (about 1 out of 10 relatives gets sick), so in such cases we opt for the prevention or examination already at the slightest suspicion of the disease.

With a life-long gluten-free diet, celiac disease is completely curable and patients are at no more at risk for complications than healthy people.

But untreated celiac disease can cause a variety of complications, which are by the time of occurrence divided into short, medium and long term effects.

Short-term complications include bloating, gas, flatulence, weight loss, hair loss, skin inflammation, burning tongue sensation, general fatigue, etc., since the food is digested poorly, as a result of damage to the lining of the gastrointestinal tract.

The medium-term complications arise due to the lack of absorption of nutrients from food. We are talking mostly about anaemia due to iron deficiency, or vitamin B group deficiency, not so much about osteoporosis, etc.

The long-term complications, which pose the most danger to patients with celiac disease, are various autoimmune and cancerous disorders. Neither type is very common, but in patients with celiac these diseases occur significantly more than in healthy people. It is estimated that the mortality of patients with celiac disease is 1.3-times higher than that of the average population.

In those suffering from celiac disease, the most common autoimmune diseases are the autoimmune inflammation of the thyroid, vitiligo, diabetes mellitus, systemic connective tissue diseases, autoimmune hepatitis, etc.

Cancer often affects the digestive tract, so after the age of 40 it is also important to perform preventive endoscopic examinations (gastroscopy, colonoscopy). Due to the constant stimulation of the immune system in untreated celiac disease, a lymphoma often develops, particularly the enteropathy-associated T-cell lymphoma in the small intestine (EATL).

A celiac disease patient's diet requires a strict life-long suspension of all foods containing gluten, i.e. wheat, spelt, Khorasan wheat, rye, barley, and sometimes also oats. The ingested gluten triggers an immune response within the body, which gradually leads to the damage of the intestinal mucosa. This causes digestive disturbances when ingesting heavy foods, which is reflected in the form of bloating, diarrhoea and other problems. Therefore, most of often, the patients do not experience problems immediately after the consumption of a meal containing gluten, but rather after greasy food, milk, etc.

It takes a several-month lasting gluten-free diet without any "misdemeanour" for the mucous membrane to heal and the symptoms to subside. Already an amount greater 10 mg - this means a pinch of flour - can have a harmful impact. Since small amounts of gluten are often present in many other processed foods, gluten-free diet is particularly complex for the patient. Without the fear of dietary transgression, the patients can only consume unprocessed products which are naturally gluten-free (fruits, vegetables, milk, meat, etc.), otherwise only those products are safe, where it is clearly stated that they do not contain traces of gluten, meaning, that they are produced in a way where the product does not come into contact with wheat. Most of these products have been made by specific manufacturers who, under strict supervision, manufacture only gluten-free products - bread, pastry and pasta from other cereals which pose no risk for patients with celiac disease: corn, buckwheat, millet, rice, quinoa, etc.

In addition to celiac disease, gluten or bread products can cause other problems.

Particularly in children, allergy to wheat is common, but it has different immunological basis and requires a different diet as well as presenting with different complications than celiac disease.

Nowadays, there is much talk also about gluten sensitivity, which is an inherent problem associated with the direct toxic effects of gluten in the intestines and the activation of natural immune mechanisms. Since we have begun to encounter celiac disease more frequently in everyday life, many people without the disease began to use gluten-free products and some noticed that after a diet without morning cereal, bread and pasta they feel much better. It is remarkable, however, that tests have not confirmed any wheat allergy or celiac disease in these individuals.

At first it seemed that avoiding gluten was just a fad, but today we know that gluten can indeed cause a wide range of problems which tend to be less pronounced than in celiac disease. Patients describe the discomfort, the feeling of bloating and heaviness in the abdomen, fatigue after meals, deconcentration of attention and 'foggy' mind, malaise, etc. These symptoms have not yet been explained in detail, nor are we able to predict the course of the disorder since there are no simple diagnostic tests yet. In search for the diagnosis, we mostly rely on trial diets and different gluten levels in diet, but of course, prior to that we first eliminate the possibility for celiac disease. According to preliminary estimates, up to 6% of people are supposedly suffering from this type of gluten intolerance. Our experience shows that, unlike celiac disease, this type of gluten intolerance eventually subsides, and dietary restrictions are usually not as strict either.

After all, we all know that exaggerated consumption of white bread, pasta and pastries triggers a variety of adverse metabolic changes which negatively affect our health. In this case, the only solution is to change the diet, and not so much to avoid gluten.

In case of suspected celiac disease, we first need to test blood for specific antibodies; sometimes, the test can be ordered by personal physician, but mostly a referral must be issued for an examination by a specialist gastroenterologist. By means of a detailed interview with the patient, the specialist assesses the possibility for celiac disease or other related disorders, and orders appropriate laboratory tests. Mostly, you will have to wait a week or two for the test results. If the levels of antibodies in blood are too high, the test is followed by a gastroscopy, during which samples of duodenal mucosa are taken and later histologically examined. Characteristic changes observed in the microscopic sample confirm the diagnosis of celiac disease. At the follow-up examination by gastroenterologist (and possibly by a nutritionist) you discuss any additional tests and the appropriate diet. The success of the diet is evaluated in a few months with laboratory test, and after a year or two with a control gastroscopy as well.

The trial diet is not suitable for diagnosing celiac disease; the diet affects the changes which are characteristic for celiac disease, which blurs the results and renders the diagnosis of celiac disease impossible. Before the tests must be at least 3 months normally consume gluten.

A referral for an examination can be also to our Centre, to the gastroenterological clinic or the dispensary for food intolerances.

Unfortunately, the road to review referrals and quite complicated, waiting times very long, so we also offer self-paid orientation checks tailored specifically diagnosing celiac disease, which are described in detail in the next section directed self-payment reviews for celiac disease.

Information and appointments:
Emal: info@dc-bled.si or
Email: alergologija@dc-bled.si

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