ARTÍCULO ORIGINAL

 

CELIAC DISEASE, A SILENT KILLER.

 

Enfermedad Celiaca, un asesino silencioso.

 

 

1 Crespo Toledo F.I, Achá Uzeda F.O, Andia Mendieta J.F, López Meneses A.
1 Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca. Universitarios segundo curso facultad de medicina.
Recepción:15 de Octubre 2017 Aceptado: 20 de Noviembre 2017

 

 

---

SUMMARY

Celiac disease is a chronic autoimmune disea-se caused by the ingestion of gluten- a group of proteins present in oats, wheat, barley and rye- among genetically predisposed individuals; causing a decrease in the diet nutrients absorp-tion capacity. (1)

The identification of the disease is key to avoid disease development at the intestinal (malab-sorption syndrome) or immunological level (lupus).

Thus far, there have been no studies about the prevalence of celiac disease in the population of Chuquisaca, which is why a pre-diagnosis was made based on the key signs and symptoms in the disease to establish an approximate number of potential celiac patients.

Methods. Descriptive, cross-cutting research on 339 students -17 to 28 years old, of the Fa-culty of Medicine of the San Francisco Xavier University of Chuquisaca- participated in the study.

As a result of this study, it was established that 41 % of women and 56% of men are aware of celiac disease; while 59% and 44%, respecti-vely, have no knowledge of the disease.

Thus, the presence of signs and symptoms cha-racteristic of celiac disease was established in high rates of the studied population and an in-creased frequency of these symptoms was also found in female students.

Although they can be manifestations linked to intolerance to gluten or even symptoms of mere gastritis, with the surveys made among Medicine students, the present study shows that the celiac disease is a fact in the healthcare careers students of San Francisco Xavier University.

The main objective of our study identi-fies possible cases of celiac disease based on the pre-diagnosis supported by the sign-symptomatology presented among the students of the Faculty of Medicine.

KEYWORDS:

Celiac disease, pre-diagnosis, Sucre, prevalence.

---

RESUMEN

La celiaquía es una enfermedad crónica autoin-mune provocada por la ingesta de gluten, un conjunto de proteínas presentes en la avena, trigo, cebada y centeno, en individuos genéticamente predispuestos, generando una disminución de la capacidad de absorción de nutrientes de la alimentación.(1)

La determinación de la enfermedad es clave para evitar complicaciones a nivel intestinal (síndrome de la mala absorción) o inmunoló-gico (lupus).

Hasta la fecha, no se han realizado estudios acerca de la prevalencia de enfermedad celiaca en la población chuquisaqueña, es por eso que se elaboró un prediagnóstico en base a los signos y síntomas claves en la enfermedad para establecer una cantidad aproximada de posibles pacientes celiacos.

Métodos. Diseño descriptivo de corte transversal y participaron en la determinación, 339 universitarios, de 17 a 28 años, de la facultad de Medicina de la Universidad San Francisco Xavier de Chuquisaca.

Como resultado de este estudio, se estableció que el 41 % de las mujeres y el 56% de los hombres tienen conocimiento sobre la celiaquía mientras que el 59% y el 44%, respectivamente, no tiene conocimiento de la enfermedad.

Así también se establecieron la presencia de signos y síntomas característicos de la enfermedad celiaca en altos porcentajes de la población estudiada, también se registró una mayor frecuencia de los mismos en estudiantes mujeres.

Si bien pueden ser manifestaciones de una intolerancia al gluten o inclusive alguno más de los síntomas de una simple gastritis, con las encuestas realizadas a los estudiantes de Medicina, el presente estudio demuestra que la enfermedad celiaca es una realidad en el área de salud de la Universidad San Francisco Xavier.

El objetivo principal de nuestro estudio, identifica posibles casos de enfermedad celiaca en base al pre-diagnóstico apoyado en la sig-no-sintomatología que presentan los estudiantes de la facultad de Medicina.

PALABRAS CLAVE:

Enfermedad celiaca, prediagnóstico, Sucre, prevalencia.

---

 

 

INTRODUCTION

Celiac disease is the standing intolerance to gluten -present in wheat, oats, barley and rye- that triggers in genetically predisposed individuals, a serious injury in the small intestine mucosa.

Caution should be exercised regarding industrialized food-products, as they may contain gluten as ingre-dient. It is necessary to refer to suitable Food and Medications lists. Ingestion of small amounts of gluten, continuously, can lead to significant intestine disorders.

These cereals are widely found in Bolivians' diet, which is why the importance of this research and the different effects caused by their consumption.

Celiac disease has three clinical forms that can ap-pear differently and at different ages. Characteristical-ly, celiac disease reveals itself during childhood and before school age. The classic forms usually appear months afterthe introduction of gluten in the diet. As a consequence of this malabsorption syndrome, there is weight loss, hypokaelemia, undernourishment, apathy and muscular atrophy. In adults, these manifestations tend to be scarce.

Hence, the diagnosis and screening of celiac patients' first-degree relatives is important. Other groups in which it is mandatory to screen for the disease are: patients with diabetes mellitus type 1, thyroid and liv-er autoimmune diseases, connective tissue diseases (such as Sjögren's syndrome), Down and Turnersyn-dromes and selective IgA deficieney. (3) The typical epigastric pain or epigastric burning that are associat-ed with swelling and Tympanites.

It is vital to keep in mind that the probability of suf-fering from celiac disease increases in certain risk groups. These include primarily first-degree relatives and certain autoimmune diseases.

Several studies are carried out to confirm this disease; for example, the serology test, intestinal biopsy, auto-antibodies with TTGA (tissue transglutaminase) and blood count, with these tests celiac disease is diag-nosed. (4)

Currently, the conditions for diagnosis in the countries of the region are characterized by lack or lack of avail-ability of serological antibodies, limitations for biopsy studies of the duodenum-jejunal mucous and restric-tions of genetic markers that have limited the figures related to the celiac disease.

The only treatment available is a strict and for life diet without wheat, oats, barley and rye. It is advisable to never start the diet without a prior biopsy that justifies it. It is suitable that celiac diet also includes natural food, such as: milk, meat, fish, eggs, fruits, vegetables, pulses and gluten-free cereals (rice and corn).

Figure 1 Gluten Food: Restricted

1.    Wheat, rye, oats and barley flour.

2.    Bread, buns, cakes, pies, cookies, biscuits, and other pastry products, made with any of these flours.

3.    Italian pasta or similar, such as: noodles, noo-dles and wheat flour/semolina.

4.    Milkshakes and malted food. Chocolates (ex-ceptthose authorized).

5.    Infusions and beverages prepared with cereals, beer, malt and barley water.

6.    Manufactured products in which any of the aforementioned flour kinds comes into its com-position, for example: ready-to-serve soups, custards, and prepared flans, ice cream and candies.

Source: "Enfermedad Celiaca", Polanco Isabel Figure N° 2: Gluten Food: Allowed

1.    Milk and its by-products (cheese, curd, butter and cream)

2.    Meat, fish, shellfish and eggs.

3.    Vegetables, fruits and tuber vegetables (pota-to)

4.    Rice, corn, in the form of flours and grain and popcorn.

5.    Tapioca, soy and soy flour.

6.    Pulses: lentils, chickpeas and beans.

7.    Dry Fruits.

8.    Sugar and honey.

9.    Oils, margarine (without additives).

10.  Salt, vinegar, yeast without gluten, pepper.

Source: "Enfermedad Celiaca", Polanco Isabel

Celiac disease is a common condition that affects approximately 1/100 people in Sucre-Bolivia, being more frequent in women. A significaní rate of patients (75%) are undiagnosed (6), hence the need to carry out an thorough search for symptoms or combinations of symptoms that should arouse clinical suspicion, in addition an important consideration is to identify key signs and symptoms to be able to perform a pre-di-agnostic examination in a quick and inexpensive way since this disease is often confused with gastritis. (7)

The main objective of this study is to identify possible cases of celiac disease based on a pre-diagnosissup-ported by the sign-symptomatology presented among of the healthcare careers students of the of San Francisco Xavier de Chuquisaca University, 2017.

 

Materials and Methods

A Descriptive, observational cross-cutting study was carried out. The research subjects were 339 university 17-28 years old students of Medicine school in San Francisco Xavier de Chuquisaca University. Ad-ministrators, professors, university students from oth-er faculties and any other person from San Francisco Xavier University were excluded.

To provide a pre-diagnosis, a survey based on the celiac disease sign-symptomatology was elaborated. The techniques used in this study are those of stratified sample, since the population is divided into subgroups or "strata" according to the degree of knowledge they have, and if this is the case, the degree of disease in studied individuals.

 

Results

A total of 339 undergraduates from the Faculty of Medicine of the San Francisco Xavier University were studied, 58% of them were women and 42% were men. Byagegroups, 14.5% of them were 17-18 years old, 32% 19-20 years old, 28% 21-22 years old, 20% 23-24 years old, 4.5% 25-26 years old and 1%, 27-28 years.

 

The graphs show that of 100% of the entire women population in Medicine School, 59% has never heard about celiac disease and 41% has a slight idea of what celiac disease is.

Likewise, of the 100% of the men population in the Faculty of Medicine, 56% has never heard about celiac disease and 44% has a slight idea of what celiac disease is.

 

Of 100% of the studied men population in the Faculty of Medicine, 21% has never heard about gluten and 79% has a slight idea of what gluten is.

Of 100% of the surveyed population of women in the Faculty of Medicine, 24% has never heard about gluten and 76% has a slight idea of what gluten is.

 

Of the 100% of the male population, 75% does not have abdominal pain related to the intake of heavy food and 25% if it presents abdominal pains related to the intake of heavy food.

Of 100% of the female population, 56% does not present abdominal pains related to heavy food intake and 44% does experience abdominal pains related to heavy food intake.

 

Of 100% of the male population, 79% does not have long periods of pain on the left or right side of the abdomen radiating to the back or lower belly and 21% does not have long-term pain on the left or right side of the abdomen irradiated towards the back or lower belly.

Of 100% of the female population, 73% does not have long periods of pain on the left or right side of the abdomen radiating to the back or lower belly and 27% does not have long-term of pain on the left or right side of the abdomen radiated towards the back or lower belly.

 

Of 100% of the male population, 24% has gastritis, 3% has acidity, 4% has gastritis and acidity, 4% has anemia, 2% has gastritis, acidity and anaemia, 1% has gastritis and anaemia, 2% has gastritis, acidity and fatty liver and 1% have fatty liver, highlighting that 60% of the total male population does not have any of these conditions.

Of 100% of the total female population, 17% has gastritis, 4% has gastritis along with acidity, 7% has heart-burn, 1% has fatty liver, 10% has anaemia, 1% has gastritis, acidity and fatty liver and 1% has gastritis, acidity and anaemia, stressing that 69% of the total female population does not have any of these ailments.

 

FINDINGS AND RECOMMENDATIONS

It was concluded that there is a very low rate of celiac disease in medicine students. Several of the students show -in their answers- some of the key symptoms for the diagnosis of this disease.

Although they can be manifestations of gluten intol-erance or even some symptoms of a simple gastritis, through the surveys made to the students of Medicine by the present study, the results show that the celiac disease is a fact in health careers of San Francisco Xavier University.

At the same time, thanksto the achieved results, it can be stated that celiac disease is not considered and treated in a suitable way. Since it is an immunosuppressive disease, when not diagnosed in time, it triggers long complications; which can be seen in some surveyed individuals, who also have very insufficient knowledge aboutthis disease.

For this reason, it is recommended that the relevant authorities foster health programs and government policies aimed at prevention as well as information campaigns on what celiac disease implies. Thus, the general population can take into account typical symptoms of the disease which are usually mistaken for common gastrointestinal diseases, in order to diagnose it in time.

 

BIBLIOGRAPHIC REFERENCES

1.- PolancoAlluéI,RibesC, SáezL, Riestra Menéndez S, Fonseca Capdevila E, Menchén Viso L, Oreste Lo Iacono, Vivas Alegre S,a Ruíz de Morales, Casellas Jordá F, Esteban Luna B, Márquez Infante M, Román Martínez Álvarez J, Villarino Marín A, Vanni Lorente D, Vitoria Cormenzana JC, Castaño González L, Ramón Bilbao Catalá

J, Arranz E, Garrote JA, Morón Flores B, Megías Guijo M, Sousa Martín C, Sanz Y, Marcos, Nova E. Libro Blanco de la Enfermedad Celiaca, 2da ed. Barcelona:ICM;1996.

2.- Ortuño DR, Escalante DR, ¿Qué sabemos de la Enfermedad Celiaca?, Revista Boliviana de Medicina, 2015, v. 1.        [ Links ]

3.- Velasco Benítez CA, "Enfermedades Digestivas En Niños" En: Colombia 2006. Ed: Programa Editorial Universidad Del Valle ISBN: 958-670-484-X v. 1pag. 648.        [ Links ]

4.- Arce Díaz T, Arguelles Arias F, Arranz E, Camarero Salces C, Esteban Luna B, Fonseca Capdevilla E, Gálvez Bueno G, García Novo D, Herrerías Gutiérrez JM, Márquez Infante M, Polanco Allué I, Ribes Koninckx C, Sáez LR, Rodríguez López JA, Ruiz Moreno M, Saucedo A, Silva García G, Villar Rodríguez JL, Asociación de celiacos Madrid, Todo sobre la enfermedad celiaca, Madrid, Edita: Consejería de Sanidad y Consumo; 2013.        [ Links ]

5.- C. Coronel Rodríguez, B. Espín Jaime, M.C. Guisado Rasco, Enfermedad Celiaca, Centro de Salud Amante Laffón, Sevilla-España, Pediatr Integral, 2015.        [ Links ]

6.- Espada M, Depresión, Gluten y Enfermedad Celiaca, Revista Sin Gluten, 2015, v. 1pag3.        [ Links ]

7.- Espada M, Salud Emocional, Autocompasión y Celiaquía, Revista Sin Gluten, 2015, v. 1pag3.        [ Links ]

8.- Taborga X, Celiaquía una enfermedad encubierta, 2016, Revista Boliviana de Medicina Interna, v. 1pag4.        [ Links ]

9.- Bustamante D, Moyano de San Rafael N, Historia de la celiaquía, editor: Universidad Nacional De Cuyo, Mendoza-Argentina, 2009, pag47.        [ Links ]

10.  Polanco, Alvaréz, Arguellez, Arrans IRF. Enfermedad Celiaca Presente y Futuro Allue IP, editor. Madrid- España: Ergon. C/ Arboleda, 1. 28221 Majadahonda (Madrid); 2013.        [ Links ]

11.  Arce, Arguellez, Arranz, Camarero,Esteban TFECB. Todo Sobre Enfermedad Celiaca. 2da. ed. Madrid-España: Consejería de Sanidad y Consumo; 2010.        [ Links ]

12.  Sfoggia C, Enfermedad celiaca Síntomas y trastornos psicológicos, editor: Academia Edu, Argentina, 2015.        [ Links ]

13.  Sfoggia C, Longarini G, Costa F, Vázquez H, Mauriño E, Bai J, Calidad de vida y distrés psicológico en la enfermedad celiaca, Buenos Aires, Argentina, 1^a edición, 2012        [ Links ]

14.  Defensor del Pueblo, La situacion de las personas con enfermedad celiaca en España, Madrid, Eduardo Dato, 31 -28010 Madrid, 201, Pag98.        [ Links ]

15.  Baí, Botero, Litwin, Martin JANG, Guía práctica sobre diagnóstico y tratamiento de la enfermedad celiaca en el primer nivel de atención Argentina, editor: MdSd,Buenos Aires-Argentina; 2011.pag4.        [ Links ]