Probiotics: a supplement to the gluten-free diet in celiac disease

Celiac disease is an enteropathy caused by intolerance to gluten, with genetic and environmental factors playing a key part in its pathogenesis. This review addresses the use of the gluten-free diet as the primary treatment for patients with celiac disease and the use of probiotics as an adjunctive therapy. The gluten-free diet is the sole treatment for preventing symptoms and allowing the inflamed intestinal mucosa to recover. The gluten-free diet, however, also has some very significant challenges like its complexity, the need for ongoing monitoring by dieticians, and the risk of contamination with gluten even in gluten-free labelled foods. At the same time, the growing interest in the use of probiotics as an adjunct therapy in celiac disease management is based on the hypothetical contribution of the gut microbiota to the pathophysiology of the disease. It has been hypothesized that gut dysbiosis could be involved in the development and maintenance of celiac disease symptoms. Probiotics, in particular the genera Lactobacillus and Bifidobacterium, are among the promising adjuvants for the improvement of gut health. These beneficial microorganisms may play an essential important, crucial role in the breakdown or modification of gluten polypeptides and in the reduction of intestinal epithelial cell damage caused by gliadin. While probiotic use is not a replacement for a gluten-free diet, it can have additive benefits by assisting in the preservation of a healthy balance of gut microbiota and lessening some chronic gastrointestinal symptoms.