Editorial: Gluten-Related Disorders: Pathogenesis, Diagnosis, and Treatment

Simone Baldi ¹ Ángela Ruiz-Carnicer ² Isabel Comino ² Carolina Sousa ² Amedeo Amedei ^1*

• ¹ University of Florence, Florence, Tuscany, Italy
• ² Sevilla University, Seville, Andalucia, Spain

Regarding CD treatment, a strict lifelong GFD remains the cornerstone; however, adherence is often challenging due to high costs, dietary restrictions and social implications. Recent phase 2 clinical trials exploring non-dietary pharmacological therapies for CD underscore the need for more extensive research, as no proposed treatments have yet shown significant efficacy in preventing gluten-induced histological damage https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2024.1501817/full. Hence, larger and more rigorous clinical trials are necessary to assess their long-term safety and effectiveness. A promising therapeutic approach involves exopeptidases, enzymes that break down gluten-derived peptides in the gastrointestinal tract, potentially reducing the immune response and alleviating CD symptoms. Although still under investigation, this strategy holds potential for improving current treatment options and enhancing quality of life for CD patients https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2024.1425982/full . The development of gluten-free food products, such as cookies, is being evaluated for their physicochemical and sensory properties ensuring that CD patients have access to safe, nutritious and palatable food options https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2023.1304117/full. The availability of high-quality gluten-free foods plays a crucial role in promoting dietary adherence and improving patient's overall experience with GFD. Beyond dietary restrictions, the psychosocial burden of CD is becoming increasingly apparent. The need to evaluate health-related quality of life (HRQoL) in CD patients is critical, as dietary limitations often contribute to social isolation, anxiety and psychological distress. These challenges are further exacerbated by diagnostic difficulties and the constant need to avoid gluten exposure. Recent research comparing general and disease-specific HRQoL questionnaires have provided deeper insights into the psychosocial impact of CD https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2024.1396589/full. A study conducted in Portugal highlighted the necessity of a comprehensive care model integrating both medical and psychosocial support. Such a holistic approach is essential for enhancing patient outcomes and ensuring that individuals with CD can maintain a fulfilling quality of life despite the challenges of their condition https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2024.1372369/full. In conclusion, significant progress has been made in understanding the pathogenesis, diagnosis, and treatment of gluten-related disorders. While the GFD remains the primary treatment, emerging pharmacological therapies, such as exopeptidase-based approaches, offer potential alternatives for individuals struggling with gluten avoidance. Additionally, increasing awareness of the psychosocial impact of CD underscores the importance of a multidisciplinary care approach that addresses both physical and emotional well-being. Looking ahead, effective management of gluten-related disorders will require precise diagnostic tools, innovative therapies and a patient-centered, integrative approach to optimize clinical care and enhance quality of life.