Enfermedad celíaca

Abstract

According to the guidelines published in 2012, The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) defines the celiac disease as a “permanent immune-mediated systemic disease caused by gluten and related prolamines in genetically sensitive people. It is characterized by the presence of a variable combination of clinical manifestations dependent on gluten, specific celiac antibodies, haplotypes HLA DQ2 or DQ8 and enteropathy. It is known that there is a hereditary predisposition with incomplete penetration, since first degree family members have 20 times more risk of suffering it and developing it because of the interactions between genetic, immunological and environmental factors, in which the gluten prolamines are the principal environmental factor. The clinical spectrum is like an “iceberg,” in which the symptomatic forms would only be the visible part while the rest would still be undiagnosed. Treatment is currently strictly avoiding gluten in the diet over the entire lifetime. Although there are many lines of investigation, it is still early to implement these alternatives given that there are few preclinical studies. The discovery of the human anti-tissue transglutaminase antibody meant a significant advance in its diagnosis. This is the serological method of choice for screening and follow-up of celiac disease since it has high predictive value, high sensitivity and specificity, and it can be performed comfortably and relatively economically. Currently, we should always refer the cases of suspicion to the child gastroenterologist. However, once the diagnosis has been confirmed, the patient should also be referred to the Primary Care pediatrician for followup. It must be remembered that the patient will soon stop being an ill child and will become just a celiac child, and that subsequent controls needed at an individual and family level will not require specialized medical attention, but a better knowledge of how its family structure and socio-economic environment work. Therefore, the suitable disease control will not be achieved until there exists the coordination and collaboration of all the resources involved, including medical attention and the information through celiac associations.