Celiac disease: From pathophysiology to treatment

Abstract

Celiac disease, also known as “celiac sprue”, is a chronic inflammatory disorder of the small intestine, produced by the ingestion of dietary gluten products in susceptible people. It is a multifactorial disease, including genetic and environmental factors. Environmental trigger is represented by gluten while the genetic predisposition has been identified in the major histocompatibility complex region. Celiac disease is not a rare disorder like previously thought, with a global prevalence around 1%. The reason of its under-recognition is mainly referable to the fact that about half of affected people do not have the classic gastrointestinal symptoms, but they present nonspecific manifestations of nutritional deficiency or have no symptoms at all. Here we review the most recent data concerning epidemiology, pathogenesis, clinical presentation, available diagnostic tests and therapeutic management of celiac disease.

A woman with a 10 year history of abdominal pain

“…It occurs in about 1% of the worldwide population 1. Factors that increase risk for the disease include genetics and the use of antibiotics.…”

“…However, false negatives can be observed in individuals who have concurrent IgA deficiency and tTG-IgG testing might also be recommended. Antigliadin (AGA) antibodies are no longer a standard of practice for diagnosis because of low sensitivity and specificity 1. Autoimmune disorders, cancer, liver disease, and infectious processes can also yield abnormal anti-tTG levels on analysis.…”

CeliacNet: Celiac Disease Severity Diagnosis on Duodenal Histopathological Images Using Deep Residual Networks

“…Gluten consumption by people with CD can cause diarrhea, abdominal pain, bloating, and weight loss. If unrecognized, it can lead to anemia, decreased bone density, and, in longstanding cases, intestinal cancer [1], [2]. An intestinal (duodenal) biopsy, obtained via endoscopic evaluation, is considered the "gold standard" for diagnosis of CD.…”

A histomorphometric classification system for normal and inflamed mouse duodenum—Quali‐quantitative approach

“…A variety of inflammatory gut alterations are hallmarks of CD, FPIGD and FPIES intensity, and these have been standardized for humans . To this day, there is no standard for experimental gut inflammation models, and various research groups developed their own classification scores .…”

“…12 A variety of inflammatory gut alterations are hallmarks of CD, FPIGD and FPIES intensity, and these have been standardized for humans. [13][14][15] To this day, there is no standard for experimental gut inflammation models, and various research groups developed their own classification scores. 16 Most models induce small intestine inflammation either through pathological agents 17 (eg Heligmosomoides polygyrus) or using transgenic mice 18 (eg Roquin-deficient mice), whereas our group targets to replicate the intestinal manifestations observed in humans allergic to food.…”