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Comprendre la maladie cœliaque: causes, symptômes et traitement
La maladie cœliaque se manifeste par des lésions chroniques de divers tissus de la surface intestinale. C’est une maladie auto-immune influencée par des facteurs environnementaux et génétiques. Chez les personnes génétiquement prédisposées, la consommation de céréales comme l’orge, le blé et le seigle déclenche une réaction immunitaire. Le gluten , une protéine présente dans ces céréales, est perçu comme une substance toxique par le système immunitaire.
Initialement considérée comme une maladie digestive, la maladie cœliaque a été examinée en profondeur dans de nombreuses études récentes. Ces recherches ont démontré que la maladie impacte gravement de nombreux systèmes : neurologique, psychologique, hormonal, rhumatologique et cardiologique. Le manque de connaissances sur cette maladie retarde souvent son diagnostic, entraînant des retards de croissance et de développement, surtout chez les enfants. Il est donc crucial de disposer d’informations précises sur la maladie cœliaque et l’intolérance au gluten pour soutenir un développement sain.
Qu’est-ce que la maladie cœliaque ? Une surface intestinale saine est tapissée de structures saillantes appelées villosités. Ces villosités facilitent le mouvement des aliments dans l’intestin et l’absorption des nutriments digérés. Dans la maladie cœliaque , la consommation de gluten endommage ces villosités, perturbant ainsi le bon fonctionnement intestinal. Lorsque le gluten est consommé, les peptides de gliadine qu’il contient se combinent avec des molécules HLA de classe II, déclenchant une réaction immunitaire.
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Les cellules immunitaires des patients cœliaques considèrent la gliadine comme toxique, ce qui entraîne une forte réponse immunitaire humorale et cytotoxique. La molécule de gliadine, en particulier le peptide 33-mer qu’elle contient, initie une réponse inflammatoire chez les personnes génétiquement prédisposées. Lors de l’absorption de cette molécule, des anticorps anti-gliadine (AGA), anti-endomysial (EMA), anti-transglutaminase tissulaire (Anti-dTG), et anti-réticuline (ARA) se forment dans le sang.
La réponse auto-immune cible l’enzyme transglutaminase tissulaire, présente non seulement dans les cellules intestinales, mais aussi dans de nombreux autres organes. Ainsi, la maladie cœliaque ne se limite pas au système digestif , mais affecte l’ensemble du corps chez les personnes sensibles au gluten.
Quelles sont les causes de la maladie cœliaque ? Les facteurs génétiques jouent un rôle important dans l’émergence de la maladie cœliaque , mais les facteurs environnementaux sont également cruciaux. Même les personnes génétiquement prédisposées ne montrent aucun symptôme de la maladie tant qu’elles ne consomment pas de gluten.
C’est pourquoi on observe fréquemment la maladie cœliaque dans les sociétés dont l’alimentation repose principalement sur le blé et d’autres céréales contenant du gluten. La durée d’exposition au gluten est directement proportionnelle à la durée de la réponse immunitaire de l’organisme et au développement de la maladie. Lorsque le gluten pénètre dans l’organisme, des peptides de gliadine toxiques se libèrent et déclenchent la réaction du système immunitaire.
Quels sont ses symptômes ? Les premiers symptômes de la maladie cœliaque se manifestent généralement par des modifications du système digestif. Parmi ces symptômes, on trouve la perte d’appétit, la diarrhée chronique ou la constipation chronique, les douleurs abdominales et les vomissements récurrents, une petite taille sans cause apparente, un retard de puberté significatif, une anémie ferriprive résistante au traitement et l’ostéoporose.
Le tableau clinique de la maladie cœliaque varie beaucoup. Les dommages causés aux villosités entraînent une malabsorption dans l’intestin grêle, ce qui affecte le fonctionnement de nombreux systèmes de l’organisme, y compris le système digestif. Les symptômes cliniques courants associés à la maladie cœliaque incluent :
Des selles grasses et ternes ainsi que des défécations fréquentes et abondantes.
Dans la forme classique de la maladie, la plupart des symptômes sont liés au système digestif et apparaissent souvent entre la 6ᵉ et la 24ᵉ semaine de vie, avec l’introduction de l’alimentation complémentaire. Généralement, les troubles digestifs tels que la diarrhée chronique ou les selles molles, les nausées, les vomissements, la perte d’appétit, les douleurs abdominales et les gaz s’accompagnent d’un retard de croissance et de développement.
La forme non classique et non digestive de la maladie se manifeste principalement chez les enfants de plus de 5 à 7 ans et chez les adultes. Les symptômes courants incluent une petite taille, un retard de puberté, une détérioration de l’émail des dents, des ulcères aphteux récurrents dans la bouche, une anémie ferriprive résistante au traitement, des maladies squelettiques liées à l’ostéoporose ou à une faible densité osseuse, des troubles du muscle cardiaque comme la cardiomyopathie et l’arthrite chronique. Outre les dysfonctionnements hépatiques et les troubles neurologiques , les troubles digestifs tels que les douleurs abdominales récurrentes, les nausées et vomissements, la sensation de ballonnement, la constipation et le reflux gastro-œsophagien sont également présents. 🔵 À LIRE AUSSI > Symptômes et causes de l’anémie : Comment la traiter efficacement ?
Chez les adultes, une éruption cutanée appelée dermatite herpétiforme est un symptôme courant. Les éruptions maculopapuleuses apparaissent surtout sur les bras, les jambes, les fesses, le visage, le cou et le tronc.
En réponse à la réaction immunitaire, diverses maladies dermatologiques telles que la dermatose linéaire à IgA, l’œdème angioneurotique héréditaire, la vascularite cutanée, l’érythème noueux, l’urticaire, le vitiligo et la pelade peuvent se manifester.
Des ulcères de type aphte peuvent aussi apparaître sur la muqueuse buccale et/ou génitale à cause de carences en fer, en zinc, en acide folique et en vitamine B12. Comment diagnostiquer la maladie cœliaque ? La maladie cœliaque est une affection complexe et durable qui impacte profondément les habitudes alimentaires d’une personne. Il est crucial d’assurer un diagnostic précis. En présence de symptômes classiques ou non classiques, la première étape consiste à détecter les anticorps dans le sang.
Ces tests, qui recherchent les anticorps développés contre le gluten et les lésions de la muqueuse intestinale, sont considérés comme la méthode de dépistage la plus fiable. Cependant, la biopsie de l’intestin grêle reste la référence en matière de diagnostic. Cette procédure est particulièrement utile pour éliminer les doutes dans les formes non classiques de la maladie cœliaque, qui ne présentent pas de symptômes digestifs clairs.
Qu’en est-il du traitement ? La maladie cœliaque se déclenche chez les personnes génétiquement prédisposées lorsqu’elles consomment des protéines de gluten. Le seul traitement accepté est un régime sans gluten à vie. Tant que la personne évite les aliments contenant du gluten, elle ne développe pas la maladie et maintient un bon fonctionnement intestinal.
Les personnes atteintes de la maladie cœliaque devraient privilégier des alternatives comme le maïs et le riz, qui ne contiennent pas de prolamines toxiques, plutôt que des céréales avec du gluten. Pour suivre correctement un régime sans gluten, il est essentiel de prévenir la contamination croisée lors de la préparation des aliments et de cuisiner dans des environnements totalement sans gluten.
Comment prévenir la maladie cœliaque ? La prévention de la maladie cœliaque repose principalement sur le maintien d’un régime sans gluten. Même une personne génétiquement prédisposée peut prévenir le développement de la maladie en adoptant ce régime. En évitant le gluten, on évite les problèmes digestifs comme la diarrhée, les douleurs abdominales, les nausées et les ballonnements, ainsi que les dommages à la surface intestinale et les troubles d’absorption. Ainsi, malgré un diagnostic de maladie cœliaque, également appelée entéropathie au gluten, la maladie peut être évitée.
Régime sans gluten : quelles conséquences en cas de non-respect ? Dans la forme classique de la maladie cœliaque, les symptômes digestifs apparaissent tôt, ce qui altère considérablement la qualité de vie et facilite le diagnostic. Cependant, les formes atypiques non classiques présentent des symptômes moins évidents, ce qui entraîne souvent un retard dans le traitement par un régime sans gluten. Le non-respect du régime provoque alors de graves troubles dans de nombreux systèmes de l’organisme.
La maladie cœliaque, étant directement liée au mécanisme de réponse auto-immune , peut entraîner des perturbations dans la production d’autoanticorps, rendant la personne sujette à d’autres maladies auto-immunes. Parmi celles-ci figurent la sclérose en plaques (SEP), la polyarthrite rhumatoïde, le diabète insulino-dépendant, le lupus érythémateux disséminé (LED), le pemphigus vulgaire et la spondylarthrite ankylosante. 🔵 À LIRE AUSSI > Vésicule biliaire : fonction, maladies et traitements expliqués simplement
Avec les lésions intestinales et la malabsorption , des carences nutritionnelles apparaissent, affectant négativement le fonctionnement de nombreux systèmes. Des troubles endocriniens peuvent survenir, et chez les femmes ne suivant pas le régime sans gluten, le risque de fausse couche et d’accouchement prématuré augmente.
Ne pas suivre un régime sans gluten augmente aussi le risque de développer des tumeurs malignes. Les personnes atteintes de la maladie cœliaque qui refusent le traitement font donc partie d’un groupe à haut risque pour diverses maladies cancéreuses.