After pasta or bread you feel heaviness in your abdomen, bloating, and fatigue, and you have started thinking about gluten. Let us calmly sort out, without panic or trendy scare stories, what gluten intolerance is and how it differs from celiac disease.
What gluten intolerance is
Gluten is a protein found in wheat, barley, and rye. It is present in pasta, bread, most ready-made breakfast cereals, sauces, and some prepared dishes, and most types of beer are made from barley. Non-celiac gluten intolerance is a separate condition: there are problems with gluten and similar symptoms, but the small intestine is not damaged. In celiac disease, the immune system attacks the body's own tissues and damages the villi of the small intestine, so nutrients are absorbed less well.
How gluten intolerance differs from celiac disease and wheat allergy
In wheat allergy, the immune system reacts to wheat proteins; there may be itchy eyes or difficulty breathing, but there is no long-term damage to the small intestine. In celiac disease, such damage is present, and it is dangerous because of complications. In gluten intolerance, the intestine is not damaged, although symptoms — abdominal pain, fatigue — may coincide.
Main symptoms: intestinal and extraintestinal
Intestinal signs: bloating, chronic diarrhea or fatty, bulky, unusually foul-smelling stool, constipation, gas, nausea, abdominal pain. Extraintestinal: fatigue, depression and anxiety, irritability in children, itchy rash with blisters, bone and joint pain, mouth ulcers or dryness. In children, there may be stunted growth and delayed puberty.
- bloating and gas after bread or pasta
- chronic diarrhea or constipation
- fatigue and iron-deficiency anemia
- itchy rash and mouth ulcers
- in children — slow growth
Why gluten intolerance occurs
The exact cause is unknown. In celiac disease, the HLA-DQ2 and HLA-DQ8 genes matter: more than 95% of people with celiac disease carry one of these variants. Some people have a silent or minimally symptomatic form, which is found in close relatives. In non-celiac gluten intolerance, osteoporosis with a risk of fractures is also possible.
How gluten intolerance is diagnosed
The doctor takes a medical history and family history and performs an examination. If celiac disease is suspected, blood tests for antibodies are used, most often to tissue transglutaminase, and a biopsy of the small intestinal mucosa during endoscopy. The tTG antibody test is 95–98% sensitive and 94–95% specific. The final diagnosis is confirmed histologically.
Why it is dangerous and when to see a doctor
Untreated celiac disease carries the risk of anemia, osteoporosis, vitamin deficiencies, pregnancy problems, and in rare cases certain types of cancer. In non-celiac gluten intolerance, osteoporosis is also possible. See a doctor if you have lost weight without reason, have persistent diarrhea, anemia, or a rash.
Gluten intolerance by itself is not a reason to call an ambulance; 103 or 112 — if marked difficulty breathing appears.
This material is for reference: it helps to understand the signs but does not replace a doctor's consultation.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer