Review and practice guidelines for celiac disease in 2014

Area of Science:

• Gastroenterology
• Immunology
• Genetics

Background:

• Celiac disease is an immune condition triggered by gluten in genetically predisposed individuals.
• Gluten ingestion causes intestinal inflammation and damage, leading to various gastrointestinal and systemic issues.
• Genetic factors, specifically human leukocyte antigen DQ2 or DQ8 alleles, are essential for disease development.

Purpose of the Study:

• To review the evolving clinical presentation of celiac disease.
• To highlight diagnostic advancements and challenges.
• To emphasize the importance of a gluten-free diet in management.

Main Methods:

• Review of clinical presentation changes over 30 years.
• Discussion of diagnostic serologic tests and intestinal biopsy.
• Analysis of treatment adherence to a gluten-free diet.

Main Results:

• Celiac disease presentations have shifted from predominantly diarrhea to atypical symptoms like anemia and bone disease.
• Serologic tests, including tissue transglutaminase and endomysial antibodies, aid in diagnosis.
• Lifelong adherence to a gluten-free diet is crucial but challenging, with adherence rates between 45% and 80%.

Conclusions:

• Celiac disease diagnosis is supported by evolving clinical awareness, serologic testing, and biopsy confirmation.
• A gluten-free diet is the cornerstone of management, though adherence remains a significant challenge.
• Understanding the genetic basis and varied presentations is key to effective celiac disease care.