What is celiac disease (CD)?

From the Guidelines

Celiac disease is an autoimmune disorder that requires a strict, lifelong gluten-free diet to manage, as evidenced by the most recent guidelines from 2024 1.

Key Considerations

• The disease is triggered by the consumption of gluten in individuals with a genetic predisposition, leading to damage in the small intestine and malabsorption of nutrients.
• Diagnosis is based on serology, specifically the presence of anti-type 2 transglutaminase antibodies, and duodenal biopsy, which shows villous atrophy and crypt hyperplasia.
• The only effective treatment is a strict, lifelong gluten-free diet, which means avoiding all foods containing wheat, barley, and rye, including hidden sources in processed foods and medications.
• Consultation with a dietitian is crucial to ensure nutritional adequacy, as patients often have deficiencies in iron, calcium, vitamin D, zinc, and B vitamins that may require supplementation.
• Cross-contamination must be avoided by using separate cooking utensils and preparation areas to prevent accidental gluten exposure.

Monitoring and Follow-up

• Regular follow-up with healthcare providers is essential to monitor adherence to the gluten-free diet and nutritional status, with a recommended follow-up schedule of every 12 months 1.
• Serology, particularly the decline in antibody levels, can be useful in assessing the effectiveness of the gluten-free diet, but its utility may vary among individuals.
• Mucosal healing can take months to years, and symptom improvement is often seen within weeks of starting the gluten-free diet.

Quality of Life and Adherence

• Adherence to the gluten-free diet is crucial for improving quality of life and preventing complications such as malabsorption, anemia, and osteoporosis.
• Lack of adherence can lead to deterioration of quality of life, and societal circumstances may affect adherence rates.
• Teenagers and young adults may be less satisfied with the impact of celiac disease on their lives and less adherent to the gluten-free diet, highlighting the need for targeted support and education.

From the Research

Celiac Disease Overview

• Celiac disease is an autoimmune disorder that causes the immune system to react to gluten, leading to small intestine damage 2
• The condition is lifelong and lacks a cure, with the only treatment being lifelong adherence to a gluten-free diet (GFD) 3, 2, 4, 5

Gluten-Free Diet

• The GFD is the only effective and safe treatment for celiac disease, but it can be challenging to follow and may adversely influence quality of life 3, 2
• The diet must eliminate gluten as an ingredient, as well as hidden components and potential cross-contamination in foods 3
• A balanced GFD should be based on a combination of naturally gluten-free foods and certified processed gluten-free products 3
• The diet must be not only free of gluten but also healthy to avoid nutrient, vitamin, and mineral deficiencies or excess 3, 6

Nutritional Considerations

• Gluten-free products tend to be poor in dietary fiber, micronutrients (such as Vit. D, Vit. B12, and folate), and minerals (such as iron, zinc, magnesium, and calcium) 6
• An inadequate macronutrient intake may occur, with a higher content of saturated and hydrogenated fatty acids, and an increased glycemic index and glycemic load of meals 6
• Nutritional education by a trained nutritionist is essential to achieve long-term satisfactory health status and good compliance with the GFD 3

Diagnosis and Treatment

• Immunoglobulin A tissue transglutaminase serologic testing is the recommended initial screening for all age groups, with esophagogastroduodenoscopy with small bowel biopsy recommended to confirm the diagnosis in most patients 4
• Genetic testing for human leukocyte antigen alleles DQ2 or DQ8 may be performed in select cases 4
• Patients with celiac disease who do not respond to a GFD should have the accuracy of the diagnosis confirmed, have their diet reassessed, and be evaluated for coexisting conditions 4