The spectrum of celiac disease: epidemiology, clinical aspects and treatment

Abstract

Celiac disease is a gluten-sensitive enteropathy that affects people of all ages worldwide. This disease has emerged as a major health-care problem, as advances in diagnostic and screening methods have revealed its global prevalence. Environmental factors such as gluten introduction at childhood, infectious agents and socioeconomic features, as well as the presence of HLA-DQ2 and/or HLA-DQ8 haplotypes or genetic variations in several non-HLA genes contribute to the development of celiac disease. Growing insight into the variable clinical and histopathological presentation features of this disease has opened new perspectives for future research. A strict life-long gluten-free diet is the only safe and efficient available treatment, yet it results in a social burden. Alternative treatment modalities focus on modification of dietary components, enzymatic degradation of gluten, inhibition of intestinal permeability and modulation of the immune response. A small group of patients with celiac disease (2-5%), however, fail to improve clinically and histologically upon elimination of dietary gluten. This complication is referred to as refractory celiac disease, and imposes a serious risk of developing a virtually lethal enteropathy-associated T-cell lymphoma.

Celiac Disease with Pure Red Cell Aplasia: An Unusual Hematologic Association in Pediatric Age Group

“…2). Radiograph of long bones showed generalized demineralization which was confirmed by DXA scan 0.408 g/cm 2 and Z score of -1.7 (-1 to -2 low normal). Chest X-ray revealed no thymic shadow or mediastinal widening.…”

“…The spectrum of presentation can be from an asymptomatic child with only positive serology to a wide range of clinical features both due to intestinal and extra intestinal involvement. The extra intestinal manifestations involve almost all organ systems [2]. The incidence of anemia varies greatly from 12 to 69 % of newly diagnosed patients with CD.…”

In vivo fluorescence imaging of exogenous enzyme activity in the gastrointestinal tract

“…The current and only treatment for CD is life-long elimination of gluten from the diet (11). This dietary restriction is a difficult experience for many patients and is often associated with decreased quality of life.…”

Is Refractory Celiac Disease More Severe in Old Europe?

“…of RCD. Villous atrophy recovers commonly in 1 year (18), and this minimum delay needs to be respected before diagnosis of refractoriness particularly in case of RCDI, as slow-responder classical celiac patients are not uncommon in adult celiac disease and architecture recovery may be observed up to 2 years aft er the beginning of the GFD ( 19 ). A second very important point is the diffi cult diff erential diagnosis between true RCDI and classical inadvertent or voluntary gluten ingestion, as it is probably the most common cause of non-response to the GFD ( 20 ).…”

“…Indeed, diff erences in celiac disease-susceptibility genotypes HLA-DQ2 and -DQ8 have been noted between New York (US) and Paris (France) populations, with HLA-DQ8 alleles more frequently observed in New York ( 24 ). Nevertheless, no diff erence was found in the clinical or pathological parameters of severity of celiac disease when the groups were compared based on HLA type ( 19 ). Moreover, other genes involved in lymphocytes signaling (genes: SH2B3 (12q34), PTPN2 (18q11), and RGS1 (1q31)) are associated with celiac disease and may be involved in the risk of developing overt lymphoma ( 25 ).…”