Awareness and understanding of gluten-related disorders (including coeliac disease and noncoeliac gluten sensitivity) has improved over the past few decades, with insights into the immunopathogenesis and genetics, as well as in serology, diagnosis, clinical features and management. The full spectrum of gluten-induced disease from sensitivity, to allergy, to autoimmune response is now appreciated, and a gluten-free diet remains the mainstay of treatment.
This special Focus on coeliac disease and gluten sensitivity from Nature Reviews Gastroenterology & Hepatology brings together key experts to provide a comprehensive overview of the most important topics in the field, providing a valuable resource for the gastroenterology and immunology communities. The Focus covers the breadth of basic, translational and clinical research. Specially commissioned articles highlight new understanding of coeliac disease and gluten sensitivity, including pathogenesis, overlap with other autoimmune diseases, gluten-related disorders in childhood, extraintestinal manifestations, refractory disease, practical insights into a gluten-free diet and the debate around noncoeliac gluten sensitivity.
Editorial
Going against the grain
Katrina Ray
doi:10.1038/nrgastro.2015.134
Nature Reviews Gastroenterology & Hepatology 12, 547 (2015)
Research Highlights
Coeliac disease: Age not important to T cells?
Christine Weber
doi:10.1038/nrgastro.2015.149
Nature Reviews Gastroenterology & Hepatology 12, 550 (2015)
In Brief
Coeliac disease: Olmesartan and risk of intestinal malabsorption and coeliac disease
doi:10.1038/nrgastro.2015.161
Nature Reviews Gastroenterology & Hepatology 12, 551 (2015)
News & views
Coeliac disease & gluten sensitivity: Epithelial stress enters the dance in coeliac disease
Nadine Cerf-Bensussan & Bertrand Meresse
doi:10.1038/nrgastro.2015.120
Nature Reviews Gastroenterology & Hepatology 12, 491-492 (2015)
Reviews
Practical insights into gluten-free diets
Jacalyn A. See, Katri Kaukinen, Govind K. Makharia, Peter R. Gibson & Joseph A. Murray
doi:10.1038/nrgastro.2015.156
Nature Reviews Gastroenterology & Hepatology 12, 580-591 (2015)
A gluten-free diet is the mainstay of treatment for patients with coeliac disease, and is still the only treatment available. In this Review, the authors provide practical insights into implementation of a gluten-free diet as a guide for clinicians, including challenges for patients, considerations for special populations, adherence and follow-up.
Novel players in coeliac disease pathogenesis: role of the gut microbiota
Elena F. Verdu, Heather J. Galipeau & Bana Jabri
doi:10.1038/nrgastro.2015.90
Nature Reviews Gastroenterology & Hepatology 12, 497-506 (2015)
Emerging evidence indicates that the gut microbiota might have a role in the development of coeliac disease. In this Review, Verdu and colleagues describe how alterations in the composition and function of the gut microbiota might influence coeliac disease pathogenesis, presenting the latest data from human and experimental studies.
Coeliac disease and autoimmune disease—genetic overlap and screening
Knut E. A. Lundin & Cisca Wijmenga
doi:10.1038/nrgastro.2015.136
Nature Reviews Gastroenterology & Hepatology 12, 507-515 (2015)
Many autoimmune diseases are known to occur alongside coeliac disease and, in some instances, patients see improvements in both if coeliac disease is diagnosed and treated. Shared genetic traits have been identified between coeliac disease and many of these forms of autoimmunity. In this Review, an overview is presented of the genetic and immunological features of coeliac disease, its overlap with other autoimmune diseases and implications for screening strategies.
Extraintestinal manifestations of coeliac disease
Daniel A. Leffler, Peter H. R. Green & Alessio Fasano
doi:10.1038/nrgastro.2015.131
Nature Reviews Gastroenterology & Hepatology 12, 561-571 (2015)
Coeliac disease is common, but remains under-diagnosed, partly because it can present with extraintestinal symptoms that do not immediately enable an accurate diagnosis of the underlying disease. In this Review, Leffler and colleagues discuss the most common extraintestinal manifestations, including dermatitis herpetiformis, gluten ataxia, anaemia, osteoporosis and others, to raise additional awareness among clinicians.
Mechanisms and management of refractory coeliac disease
Tom van Gils, Petula Nijeboer, Roy L. van Wanrooij, Gerd Bouma & Chris J. J. Mulder
doi:10.1038/nrgastro.2015.155
Nature Reviews Gastroenterology & Hepatology 12, 572-579 (2015)
A small subset of patients with coeliac disease do not respond to therapy with a gluten-free diet. These individuals are considered to have refractory coeliac disease (RCD), of which there are two known subtypes. In this Review, the authors provide an overview of RCD discussing the pathogenesis, diagnosis and management of this condition.
Coeliac disease and gluten-related disorders in childhood
Sabine L. Vriezinga, Joachim J. Schweizer, Frits Koning & M. Luisa Mearin
doi:10.1038/nrgastro.2015.98
Nature Reviews Gastroenterology & Hepatology 12, 527-536 (2015)
Gluten-related disorders are increasingly being diagnosed in children. In this Review, Vriezinga and colleagues provide an overview of the most common gluten-related disorders in children: coeliac disease, wheat allergy and noncoeliac gluten sensitivity. Pathogenesis, diagnosis and management of each condition are described.
The spectrum of noncoeliac gluten sensitivity
Imran Aziz, Marios Hadjivassiliou & David S. Sanders
doi:10.1038/nrgastro.2015.107
Nature Reviews Gastroenterology & Hepatology 12, 516-526 (2015)
Individuals are increasingly self-reporting gluten sensitivity and placing themselves on a gluten-free diet without diagnosis of coeliac disease or IgE-mediated allergy. This new clinical entity has been termed noncoeliac gluten sensitivity (NCGS). In this Review, the authors provide an overview of NCGS, including immunopathogenesis, clinical features, diagnosis and management, as well as the controversies associated with this condition.
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