Celiac Disease: A Disorder Emerging from Antiquity, Its Evolving Classification and Risk, and Potential New Treatment Paradigms

Abstract

Celiac disease is a chronic genetically based gluten-sensitive immune-mediated enteropathic process primarily affecting the small intestinal mucosa. The disorder classically presents with diarrhea and weight loss; however, more recently, it has been characterized by subclinical occult or latent disease associated with few or no intestinal symptoms. Diagnosis depends on the detection of typical histopathological biopsy changes followed by a gluten-free diet response. A broad range of clinical disorders may mimic celiac disease, along with a wide range of drugs and other therapeutic agents. Recent and intriguing archeological data, largely from the Gobleki Tepe region of the Fertile Crescent, indicate that celiac disease probably emerged as humans transitioned from hunter-gatherer groups to societies dependent on agriculture to secure a stable food supply. Longitudinal studies performed over several decades have suggested that changes in the prevalence of the disease, even apparent epidemic disease, may be due to superimposed or novel environmental factors that may precipitate its appearance. Recent therapeutic approaches are being explored that may supplement, rather than replace, gluten-free diet therapy and permit more nutritional options for future management.

Management del paziente con diarrea, nausea e vomito, malnutrizione e malattia celiaca: lo stato dell'arte

“…Inoltre i consistenti cambiamenti alimentari nella popolazione, con l'aumento dell'introduzione di grano, soprattutto nelle aree rurali a nord del fiume YangTze, potrebbero in futuro contribuire ad una esposizione maggiore della popolazione allo sviluppo di malattia. 162,163 A sfavore di un supposto maggior rischio generale di patologie e di mortalità nella popolazione con MC versus la popolazione generale, uno studio retrospettivo su 10.825 pazienti inglesi con MC, tra il 1998 e il 2012, ha documentato che nella popolazione con MC non vi era un maggior rischio di patologie digestive, respiratorie e neoplastiche, né un incremento della mortalità generale cardio-respiratoria. 164 …”

Immunopathogenesis and therapeutic approaches in pediatric celiac disease

“…The first description of celiac disease dates back to 250 A.D. by a Greek physician named, Aretaeus of Cappadocia [3]. Dutch physician, William Dicke was the first one to identify the role of wheat in triggering celiac disease [4], while the histological features were initially described by John W. Paulley [5].…”

Gluten related disorders: even a dermatological issue

“…and the human body triggers an increasing variety of symptoms, syndromes, allergic reactions, autoimmune diseases (2). The first description of a patient affected by a disorder related to gluten ingestion (celiac disease, CD) has been ascribed to Areteus of Cappadocia, who in the 2nd century AD reported a case of chronic diarrhea and malabsorption (3). This scenario appears in contrast with the wide diffusion of the genetic background susceptible to immune reactions against gluten, the HLA DQ2 and/or DQ8 haplotypes, which are essential for the development of CD (4).…”