How to diagnose gluten intolerance
The gold test to establish the definitive diagnosis of celiac disease consists of practicing a duodenum biopsy proximal or jejunum, which is a very common procedure for how to diagnose gluten intolerance in children. This test should always be carried out before removing gluten from the diet.
The intestinal biopsy consists of the removal of a piece of tissue from the small intestine to check whether or not it is damaged, which must be completed with the histological study of a sample of mucosa obtained from the end of the duodenum, in which injuries typical of celiac disease are observed.
Symptoms of gluten intolerance
The contact of the intestinal mucosa with the gluten leads to the appearance of mucosal damage whose spectrum ranges from cases in which only an increase in the population of intraepithelial lymphocytes (lymphocytic enteritis) to advanced forms of villous atrophy is seen.
It must be borne in mind that some symptoms such as diarrhea or abdominal pain, together with analytical alterations (anemia, excessive loss of fats in the stool ...), can only make us suspect the presence of celiac disease, but to confirm the diagnosis is I need to perform an intestinal biopsy.
Any of the manifestations of gluten intolerance, even the milder forms, can present with various deficiency states, including anemia, osteopenia or osteoporosis and a wide range of digestive and extradigestive symptoms. All these manifestations, as well as the serological alterations, improve sensibly and even disappear when the gluten is removed from the diet, reappearing when introducing this element again in the diet.
If the patient presents other symptoms or complications, it may be necessary to perform diagnostic tests that rule out other pathologies, or determine the existence of associated diseases, such as diabetes mellitus type 1, liver disease ...
Reasons to recommend an intestinal biopsy
1. Children In the young child the clinical picture varies depending on the time of the introduction of gluten in the diet. The most frequent clinical manifestations are: chronic diarrhea, lack of appetite, vomiting, recurrent abdominal pain, laxity and irritability, apathy, introversion and sadness. The most frequent signs are malnutrition, abdominal distension, muscular hypotrophy, pons-statural delay, iron deficiency anemia and hypoproteinemia.
2. Older children and adolescents. The older child and the adolescent may not have digestive symptoms. The disease can present as a ferropenic anemia rebellious to oral ferrotherapy, constipation, abdominal pain, delayed menarche and menstrual irregularities, headaches, arthralgias and irregular intestinal habit. The signs that most frequently present are short stature, oral aphthae, enamel hypoplasia, abdominal distension, muscle weakness, arthritis, osteopenia and follicular keratosis.
3. Adults In adults, the disease can have different patterns of presentation. The classic description of the disease that includes the manifestations of a severe malabsorption syndrome with steatorrhea and signs of malnutrition is, nowadays, exceptional. However, some adults whose disease went unnoticed in the pediatric age can debut with a picture of these characteristics, following a stressful life event, a gastrectomy or pregnancy.
Marisol New
Advice: Working Group on Early Diagnosis of celiac disease
Coordinator: Isabel Polanco Allué. Spanish Society of Gastroenterology,
Hepatology and Pediatric Nutrition
