Coeliac Disease - New Pathophysiological Findings and Their Implications for Therapy.
Coeliac disease (CD) is one of the most common diseases worldwide, resulting from a combination of environmental (gluten) and genetic (human leucocyte antigen (HLA) and non-HLA genes) factors. Depending on the geographical location, the prevalence of CD has been estimated to approximate 0.5-1%. The only treatment currently available for CD is a gluten-free diet (GFD) excluding gluten-containing cereals such as wheat, rye, and barley, and other foodstuffs with natural or added gluten. However, adherence rates and patient acceptance are often poor. Moreover, even in fully adherent patients, the diet may fail to induce clinical or histological improvement. Hence, it is unsurprising that studies show CD patients to be highly interested in non-dietary alternatives. The following review focuses on current pathophysiological concepts of CD, spotlighting those pathways which may serve as new possible, non-dietary therapeutic targets in the treatment of CD.
Department of Gastroenterology and Clinical Nutrition, Sachsenhausen Hospital, Teaching Hospital of the Goethe University Frankfurt, Germany ; Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/M., Germany.
Jürgen
J
Stein
Institute of Translational Immunology, University Medical Center, Hospital Mainz, Germany ; Division of Gastroenterology, Beth Israel deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Detlef
D
Schuppan
Coeliac disease; Gluten-sensitive enteropathy; Malabsorption; Therapeutic vaccine; Transglutaminase inhibitors; Zonulin inhibitor