Celiac Disease

Celiac disease is a chronic, immune-mediated digestive disorder that occurs in genetically predisposed individuals as an abnormal immune response to gluten, a protein found in wheat, barley, rye, and, in some cases, oats. This disease damages the small intestine by flattening the villi—finger-like structures responsible for nutrient absorption—leading to impaired absorption and a wide range of clinical manifestations.

Epidemiology and Prevalence

Celiac disease can occur at any age, in all races, and in both genders. It is estimated to affect approximately 0.03% to 1% of the population. However, due to its broad clinical spectrum—from completely asymptomatic cases to severe symptoms—determining the true prevalence is difficult. It is estimated that only about 10% of affected individuals are diagnosed.

In Türkiye, as of November 2023, 166,614 individuals have been diagnosed with celiac disease according to the Health Information Systems data. However, the number of undiagnosed individuals is believed to be much higher, representing the "hidden iceberg" of the disease.

Etiology and Pathogenesis

Both genetic predisposition (especially the presence of HLA-DQ2 and HLA-DQ8 genes) and gluten consumption are necessary for disease development. Gluten triggers an immune response in the small intestinal mucosa of celiac patients, causing villous atrophy. This leads to malabsorption and numerous systemic symptoms.

Signs and Symptoms

Celiac disease can present with intestinal and extraintestinal symptoms.

Symptoms in children:

• Abdominal pain
• Abdominal bloating
• Chronic diarrhea
• Irritability, loss of appetite
• Growth retardation, delayed height increase
• Failure to gain weight
• Vomiting

Symptoms in adults:

• Abdominal distension
• Weight loss and muscle weakness
• Anemia
• Elevated liver enzymes
• Joint and bone pain
• Itchy skin rash (Dermatitis herpetiformis)
• Gas, bloating, chronic diarrhea, or constipation
• Depression, irritability

Celiac Diagnosis Algorithm. (ResearchGate)

Diagnosis

Serological tests (anti-tTG IgA, EMA, DGP) are primarily used for screening. If these tests are positive, the diagnosis is confirmed by endoscopic small intestine biopsy showing villous damage.

It is important that gluten-containing foods are consumed before testing, as a gluten-free diet can cause false-negative results.

Treatment

The only effective treatment for celiac disease is a lifelong strict gluten-free diet. This diet:

• Eliminates disease symptoms
• Allows healing of villous structures
• Prevents long-term complications
• Improves quality of life

Basic principles of the diet:

• Avoid foods containing wheat, barley, rye, and oats
• Develop a habit of reading food labels
• Pay attention to indirect gluten sources such as food additives, cosmetics, and medications
• Prevent cross-contamination during food preparation

Safe foods include:

• All vegetables and fruits
• Unprocessed meat, fish, chicken
• Eggs, honey, jam, olives, solid and liquid oils
• Corn, rice, potatoes, and their flours
• Chickpea flour, chestnut flour, grape seed flour, soy flour
• Home-ground spices

Gluten-containing foods. (Visual prepared with AI support.)

Complications

If diagnosis is delayed or diet is not followed, serious health problems can develop:

• Malabsorption
• Deficiencies of iron, calcium, and vitamin D
• Osteoporosis
• Infertility
• Miscarriages
• Malignancies such as small bowel lymphoma

Public Health and Awareness Efforts

The Ministry of Health of Türkiye carries out various initiatives to raise awareness of celiac disease, including:

• Brochures and posters for the public and children
• Informational activities in schools
• Teacher guidance manuals on celiac disease
• Encouraging the availability of gluten-free products in school cafeterias
• Diagnosis-treatment-follow-up guides for family physicians
• Gluten-free menu guides for mass feeding systems

These efforts aim to increase early diagnosis rates, integrate undiagnosed individuals into the health system, and promote gluten-free living as a lifestyle rather than merely a treatment.

Celiac disease is a difficult-to-diagnose condition with highly variable symptoms, treatable only with diet. Raising public awareness, educating healthcare professionals, and establishing gluten-free infrastructures directly improve the quality of life for those affected. With early diagnosis and correct diet, celiac disease can become a manageable lifestyle.