Celiac disease: a comprehensive current review

Abstract

Background Celiac disease remains a challenging condition because of a steady increase in knowledge tackling its pathophysiology, diagnosis, management, and possible therapeutic options. Main body A major milestone in the history of celiac disease was the identification of tissue transglutaminase as the autoantigen, thereby confirming the autoimmune nature of this disorder. A genetic background ( HLA-DQ2/DQ8 positivity and non-HLA genes) is a mandatory determinant of the development of the disease, which occurs with the contribution of environmental factors (e.g., viral infections and dysbiosis of gut microbiota). Its prevalence in the general population is of approximately 1%, with female predominance. The disease can occur at any age, with a variety of symptoms/manifestations. This multifaceted clinical presentation leads to several phenotypes, i.e., gastrointestinal, extraintestinal, subclinical, potential, seronegative, non-responsive, and refractory. Although small intestinal biopsy remains the diagnostic ‘gold standard’, highly sensitive and specific serological tests, such as tissue transglutaminase, endomysial and deamidated gliadin peptide antibodies, have become gradually more important in the diagnostic work-up of celiac disease. Currently, the only treatment for celiac disease is a life-long, strict gluten-free diet leading to improvement in quality of life, ameliorating symptoms, and preventing the occurrence of refractory celiac disease, ulcerative jejunoileitis, and small intestinal adenocarcinoma and lymphoma. Conclusions The present review is timely and provides a thorough appraisal of various aspects characterizing celiac disease. Remaining challenges include obtaining a better understanding of still-unclear phenotypes such as slow-responsive, potential (minimal lesions) and seronegative celiac disease. The identification of alternative or complementary treatments to the gluten-free diet brings hope for patients unavoidably burdened by diet restrictions.

Non-Responsive Coeliac Disease: A Comprehensive Review from the NHS England National Centre for Refractory Coeliac Disease

“…NRCD can be categorized as primary, where there is no response to a GFD, or secondary, where individuals initially respond to a GFD, but then develop symptoms despite ongoing adherence to a GFD [3]. Some expert gastroenterologists have suggested that the definition of NRCD causes confusion, primarily because the underlying cause of symptoms in these individuals may be related, or unrelated, to CD [6]. In contrast, we consider this definition appropriate, as it puts CD at the forefront of the clinical approach when considering the causes of persisting symptoms in these patients.…”

Processed Food Additive Microbial Transglutaminase and Its Cross-Linked Gliadin Complexes Are Potential Public Health Concerns in Celiac Disease

“…Celiac disease is part of the autoimmune inflammatory disease family targeting the small intestine. The disease is triggered by the ingestion of the prolamins contained in wheat, barley, rye, or oat, by genetically susceptible individuals [39]. The average incidence of CD is 1% in the Western world.…”

Characterisation of a novel cold‐adapted calcium‐activated transglutaminase: implications for medicine and food processing

“…Research has supported the idea that the deregulated expression and function of TG contributes to pathological conditions such as cancer metastasis, tissue fibrosis, coeliac disease and neurodegenerative disorders . The coeliac disease is a gluten‐induced immune‐mediated disease characterised by a specific genetic genotype (HLA‐DQ2 and HLA‐DQ8 genes) and autoantibodies (anti‐tissue transglutaminase) . A key player is transglutaminase 2, which is able to modify gluten‐derived gliadin peptide .…”