Celiac Disease

Celiac disease (CD) is a chronic disorder caused by an inflammatory T-cell response to the storage proteins in wheat, rye and barley, which are collectively called “gluten” and characterized by the presence of typical autoantibodies (anti transglutaminase (TTG), anti endomysial, anti-deamidated gliadin peptide) and a range of histological alterations of the small bowel mucosa ranging from increased intra epithelial lymphocytes to total villous atrophy. Genetic (mainly positivity for HLADQ2 and/or DQ8), immunological, and environmental factors (such as microbiota composition, age of gluten introduction, infections etc.) are thought to be necessary for disease expression. Ingestion of gluten by genetically predisposed individuals leads to an uncontrolled T-cell-driven inflammatory response that leads to disruption of the structural and functional integrity of the small bowel mucosa. CD is treated with a gluten-free diet (GFD), which, if appropriately kept, leads to complete resolution of the clinical disease and restoration of the histological abnormalities. CD is not limited to the gastrointestinal tract and some CD patients may present with extraintestinal symptomatology (neurological, dermatological, hepatitis, arthritis etc.) CD is no longer a rare condition, and currently is the most common form of food hypersensitivity in children and adults. CD has significantly changed over the last 3 decades. Disease presentation has significantly changed and now most of the patients are asymptomatic or have atypical presentation. Diagnosis may no longer necessitate small bowel biopsy in selected symptomatic cases with repeated >10 times TTG levels and positive anti endomysial. New modalities to assess diet compliance by measuring gluten immunogenic peptides in urine or stools are now available. New emerging therapies avoiding the need for keeping gluten free diet are in the pipeline. Controversies regarding how strict the diet should be and whether or not to allow oats is an unsolved question.

In this Research Topic we aim to review several disease aspects: Diagnosis of CD, pathogenesis of CD (genetics, microbiology etc), epidemiology (including changing patterns of celiac disease, increasing rates in the east and in western countries, reasons for changing patterns), disease prevention, extra intestinal manifestations, new and emerging treatments, follow up recommendations, controversies (amount of gluten allowed/oats/ gluten containing dermatologic products etc.)  and prognosis and complications.