Update on celiac disease

Abstract

Purpose of review The purpose of this review is to describe current updates in celiac disease. Recent findings Recent developments in the understanding of the pathogenesis of celiac disease continue to emerge that may implicate the role of gluten exposure. Several studies have shown that the amount of gluten consumed by the infant may affect the age of onset of celiac disease in genetically predisposed individuals. New guidelines from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition allow serology-based celiac diagnosis, omitting endoscopic biopsies, in children. Recent data and updated guidelines in adults no longer support biopsies in all patients who are genetically susceptible with celiac disease who have been identified by serology with clinical signs and symptoms of celiac disease. A new assay was identified in the immune response to epitopes of the tissue transglutaminase–deamidated gliadin peptide complex. In addition, a recent study shows that serum IL-2 elevations correlate with timing and severity of symptoms after gluten ingested in celiac disease patients. Measuring gluten immunogenic peptides (GIPs) in the stool of celiac patients may help monitor adherence to a gluten-free diet (GFD). Of importance, we should be aware that the quality of life is affected in celiac disease patients. During adolescence, the education on the importance of long-term follow-up with an adult gastroenterologist is associated with more successful rates of medical care transition for young adults with celiac disease. Latiglutenase, an orally administered mixture of two gluten-specific recombinant proteases that degrades gluten proteins into small physiologically irrelevant fragments, is currently in a phase 2 trial. Latiglutenase has shown to be safe and effective in reducing symptoms of celiac disease patients upon a GFD with improvement of quality of life. Lastly, a recent study describes a mouse model that is characteristic of celiac disease. Summary Our knowledge of celiac disease continues to grow with increasing evidence of contributory factors to its pathogenesis. There is some evidence that the quantity ingested of gluten by the infant effects the age of onset of celiac disease in genetically susceptible patients. Changes have been made to the guidelines in the diagnosis of celiac disease proposed by new studies. Recent studies have shown the significant effects on quality of life for celiac patients. As improved laboratory methods continue to be developed, these tests can have utility in both diagnosis of celiac disease and monitoring adherence to the GFD. Current therapeutic trials offer promising nondietary treatment for celiac patients. The development of an animal model can provide a better understanding of the pathogenesis of celiac disease.

Evaluation of eye involvement in paediatric celiac disease patients

“…taken from the duodenum according to the European Society for Pediatric Gastroenterology, Hepatology and Nutrition diagnostic criteria. 22 Measurement of thicknesses of choroid and GCC layers (the thicknesses of RNFL, GCL and IPL) of optic nerve by using EDI-OCT by a trained OCT technician and ocular examination of participants were made by an ophthalmologist who were not aware about the group of children in paediatric CeD patients with 1 year gluten-free diet. Informed consent was obtained from all participants parents before procedures.…”

“…Diagnosis of CeD is based on pathology results of biopsy material taken from the duodenum according to the European Society for Pediatric Gastroenterology, Hepatology and Nutrition diagnostic criteria 22 …”

New-Level Insights into the Effects of Grape Seed Polyphenols on the Intestinal Processing and Transport of a Celiac Disease Immunodominant Peptide

“…3 One important step for the pathogenesis of CD is the enzymatic gastrointestinal hydrolysis of gluten proteins, which causes the release of certain peptides in the gut, some of them able to activate specific mechanisms of the innate and/or adaptive immune branches of the immune system. 4 To date, at least 50 different T-cell stimulatory glutenderived epitopes have been identified in their native or deamidated forms. 5 Among the high diversity of the already characterized CD epitopes, the alpha-gliadin peptide 56-88, LQLQPFPQPQLPYPQPQLPYPQPQLPYPQPQPF (32mer), stands out because of its extraordinary immunoreactivity since its sequence includes six overlapping epitopes.…”

“…In addition to environmental factors (including diet), the genetic background (HLA immunogenic DQ2 or DQ8) appears to be a major risk factor for the development of CD . One important step for the pathogenesis of CD is the enzymatic gastrointestinal hydrolysis of gluten proteins, which causes the release of certain peptides in the gut, some of them able to activate specific mechanisms of the innate and/or adaptive immune branches of the immune system . To date, at least 50 different T-cell stimulatory gluten-derived epitopes have been identified in their native or de-amidated forms .…”