Issues related to gluten-free diet in coeliac disease

In the last few years, knowledge about coeliac disease has significantly improved, resulting in a better understanding of disease pathogenesis, diagnosis and therapy. This review describes the latest progress in research concerning treatment with gluten-free diet in patients with coeliac disease.

Gluten-free diet is generally admitted as effective therapy in symptomatic patients, but a life-long dietary treatment in some challenging cases such as 'silent' and 'latent' patients is under discussion. Tolerance to gluten may be acquired later in life, but, as latency may be transient, a strict follow-up is necessary in these patients. The composition of gluten-free diet needs a better definition; latest evidence demonstrates that oats are tolerated by most patients with coeliac disease. Finally, the amount of gluten permitted in gluten-free products is still a matter of debate; significant progress has been made in the sensitivity of techniques for gluten detection, but the daily amount of gluten that can be safely consumed is not yet defined.

Gluten-free diet remains the cornerstone of therapy of coeliac disease. More studies addressing the need of gluten-free diet for cases of 'potential' coeliac disease are necessary, as well as studies linking the best available analytical detection of gluten to the clinical threshold of tolerance.