Gluten-Related Disorders: Pathogenesis, Diagnosis, and Treatment

Celiac disease (CD) is an autoimmune condition triggered by gluten consumption in individuals with a genetic predisposition. It is characterized by villous atrophy, intraepithelial lymphocytosis, and crypt hyperplasia of the small bowel. This condition is marked by chronic inflammation, which can be resolved by eliminating gluten-containing foods from the diet, known as a gluten-free diet (GFD). Although CD primarily affects the small intestine, it exhibits a wide range of symptoms, including both intestinal and extraintestinal symptoms, which can also range from mild to severe and even include subclinical forms. Based on more recent epidemiological data, loss of gluten tolerance may occur at the time of its introduction into the diet or at any time in life, suggesting that other environmental factors must play a role in CD development. Specifically, an imbalance of the gut microbiota composition and a consequent dysregulated intestinal metabolic profile, including an altered short-chain fatty acids production, has recently been related to CD onset. Even non-celiac gluten/wheat sensitivity (NCGS/WS) is a clinical entity characterized by intestinal and extraintestinal symptoms induced by gluten ingestion, but it occurs in the absence of wheat allergy or CD. The pathogenesis of NCGS/WS is still uncertain since several different substances other than gluten, such as fermentable oligo-, di-, monosaccharides, and polyols may be involved in its onset. Lastly, concerning CD (celiac disease), it has also been suggested that impaired intestinal barrier function, increased permeability, and gut dysbiosis are important factors in the development of NCGS or WS development.

Gluten-related disorders are heterogeneous conditions and thus require a multidisciplinary approach for a better understanding and management. The absence of a conclusive diagnosis often results in decreased adherence to GFD, which can negatively affect the health of those who truly suffer from gluten-related disorders. Novel insights into pathomechanisms, novel biomarkers, and additional therapeutic strategies are urgently needed to detect a pathological response more efficiently to gluten to improve clinical diagnosis and management of these diseases. Therefore, this Research Topic aims to provide new insights into the pathogenesis, diagnosis, and management of gluten-related disorders.

Topics to be covered within this Research Topic are (but are not limited to):
• Advances in diagnostic tools and monitoring of gluten-related disorders.
• Dietary management and patterns in a gluten-free diet: technological and nutritional aspects.
• Dietary interventions in Celiac Disease and Non-celiac gluten sensitivity.
• Epidemiology and new biomarkers in Celiac Disease, Gluten and Non-gluten intolerance and sensitivities.
• Preventive strategies and alternative therapies for gluten-related disorders.
• Role of microbiota and its related metabolites in Celiac Disease and, Gluten and Non-gluten intolerance and sensitivities.
• Environmental factors (microbial agents, dietary components or patterns, breastfeeding, etc.) associated with gluten-related disorders.

We welcome proposals ranging from original research to review articles to contribute to a deeper understanding of these critical arguments.