Modern concepts of celiac disease

Abstract

Celiac disease is widespread autoimmune disease, which develops in genetically predisposed individuals in case of gluten intake and manifests as enteropathy and extraintestinal signs or without symptoms. Celiac disease is recognized as one of the most common genetic diseases in the world with about 1% prevalence. The review organizes literature data concerning epidemiology, pathogenesis, clinical presentation, diagnosis and treatment of celiac disease. The historical and geographical features of the celiac disease prevalence associated with the wheat consumption and human migration are described. The disease pathogenesis caused by both genetic factors, in particular the human leukocyte antigens (HLA) type, and the environmental influence, the gluten intake. The classification uniting a number of gluten-related diseases, which differ in the development mechanism and clinical manifestations, is described. Celiac disease can clinically manifest by classic and atypical symptoms or occur in a latent form. It usually manifests in early childhood after the introduction of the cereals into diet with symptoms of chronic diarrhea, delayed growth and development. Celiac disease develops throughout life and increases morbidity and mortality if left untreated. Diagnosis is based on the presence of antibodies to tissue transglutaminase, gliadin and deamidated peptides and biopsy results. An algorithm for the interpretation of the diagnostic findings in the celiac disease diagnosis is presented. Significance of gluten-free diet and new drugs in the celiac disease treatment is highlighted. Different ways to reduce the gluten toxicity for celiac patients are described, such as gliadin hydrolysis modification, gluten intake decrease, immune response activity inhibition.