(gluten intolerance)

The prevalence is estimated at 1/100 to 200. Chronic intolerance to gluten (protein contained in grains such as wheat, barley, rye). Stimulation of the T lymphocytes causes a reaction in the mucosa of the small intestine and induces villous atrophy.

Genetics: 90% of cases are associated with antigens HLA class II DQ2 and DQ8. 

The risk is increased:

-         if a first-degree relative is affected (10 %)

-         in case of a type 1 diabetes  (4 %), trisomy 21 (8 %), Turner syndrome (4 %), dermatitis herpetiformis, autoimmune thyroid disease

The classic clinical presentation (40 % of cases) is: chronic diarrhea,  bloated stomach, weight loss and/or weight or growth stagnation. Reversible lactose intolerance, secondary to the lesions in the intestinal mucosa.

Many cases are asymptomatic or poorly symptomatic: abdominal pain, underweight etc. In the absence of treatment: anemia following iron or folate deficiency, rachitism, short stature.

Biological diagnosis:anti-endomysial IGA antibodies, tissular anti-transglutaminase antibodies, but especially antigliadin IgG and IgA antibodies.

Histological diagnosis: subtotal atrophy of the villi of the small intestine.

Treatment: gluten-free diet ( iodine supplements are necessary) .

It is possible that untreated cases incur an increased risk of small intestine cancer (lymphoma) or thyroid cancer.

Celiac disease can be associated with idiopathic pulmonary hemosiderosis: Lane-Hamilton syndrome (see this term)

Anesthetic implications: 

check hemoglobin level, weight measurement, make sure that iodine supplementation are taken (risk of fruste hypothyroidism). Risk of delayed gastric emptying for solids (not for the clear fluids).

References : 

-        Perri  F,  Pastore M, Zicolella A, Annese V, Quitadamo M, Andriulli A.
Gastric emptying of solids is delayed in celiac disease and normalizes after gluten withdrawal.
Acta Paediatr 2000; 89:921-5

-        Usai-Satta P, Oppia F, Lai M, Cabras F.
Motility disorders in celiac disease and non-celiac gluten sensitivity: the impact of a gluten-free diet.
Nutrients 2018 ; 10 : 1705; doi:10.3390/nu10111705

Updated: March 2023