Celiac disease, also called gluten intolerance, is a global public health issue and is characterized by a severe autoimmune reaction caused by the ingestion of gluten, a protein found primarily in wheat, barley and rye. In Tunisia, it is estimated that 75,000 to 100,000 people are affected, but only 30,000 cases have actually been diagnosed, which highlights a significant delay in the detection of the disease and the need to strengthen awareness and early detection.
An underdiagnosed disease with serious health implications
Due to its seriousness, the issue of celiac disease was highlighted during an awareness day organized by the Tunisian Celiac Disease Association, on Saturday December 27, 2025, in Tunis.
In this context, the president of the association, Dr. Mongi Ben Hariz, pediatrician and nutrition specialist, insisted on the fact that the gluten-free diet remains the only treatment available to date, emphasizing the absence of any medicinal alternative.
Indeed, despite scientific progress in understanding its mechanisms, the disease remains largely unknown and not treatable with medication, making the lives of patients difficult and dependent on a strict gluten-free diet for life.
An autoimmune pathology without drug treatment
Dr Ben Hariz also clarified that this disease affects individuals with a particular genetic predisposition, which explains why it does not appear in all people exposed to gluten.
Gluten ingestion triggers an abnormal immune response in the celiac patient, leading to the production of antibodies directed against the intestinal mucosa, damaging the intestinal villi and compromising the absorption of essential nutrients, a phenomenon known as villi atrophy.
The clinical consequences are varied and depend on the age and general condition of the patient, but frequently include chronic diarrhea, weight loss, stunted growth in children, anemia, vitamin and trace element deficiencies, as well as generalized weakness and fatigue.
If the disease is not properly managed by a strict gluten-free diet, it can lead to severe complications in the medium and long term, including osteoporosis, growth disorders, and in some cases, the appearance of gastrointestinal cancers after the age of 40 or 50.
Dr. Ben Hariz argued, in this sense, that the precise diagnosis of celiac disease is based on two complementary steps: a blood analysis looking for specific antibodies followed by an endoscopy with intestinal biopsy, making it possible to confirm the presence of villous atrophy.
Essential associative support in the face of a growing economic burden
Faced with these challenges, the Tunisian Celiac Disease Association plays a central role in supporting patients and their families. It organizes practical training on the preparation of gluten-free foods, teaches patients how to identify safe food products and provides an up-to-date list of suitable products.
In addition, the association is developing a network of bakeries specializing in gluten-free bread, currently active in Tunis, Sidi Bouzid and Djerba, with an expansion planned in Béja in 2026. It also supports certain families by providing the equipment necessary for the domestic production of gluten-free foods, thus helping to alleviate the economic burden imposed by this disease, amplified by an inflationary situation.
The financial burden remains considerable. Gluten-free products, often imported or manufactured in specialized channels, are significantly more expensive than conventional foods, which represents a permanent economic burden for families, especially when several members are affected. Patients must purchase specific foods daily and carefully monitor the composition of the products, which requires an investment of time and money.
Even with the monthly allowance recently increased to 130 dinars, as part of the 2026 Finance Law, these expenses frequently exceed the means of many households, highlighting a gap between official financial support and the real needs of patients.
NJ
