Coeliac disease articles within Nature Reviews Gastroenterology & Hepatology

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  • Review Article |

    Coeliac disease is an autoinflammatory disease, with the only available treatment being a lifelong gluten-free diet. Alternative therapeutic approaches are needed. This Review explores the concept of tolerance-inducing therapies for coeliac disease, highlighting the underlying mechanisms, progress, challenges and future directions.

    • Ludvig M. Sollid

  • Review Article |

    Despite advances in testing for coeliac disease over the past two decades, awareness of this disease remains suboptimal worldwide. Here, Makharia and colleagues summarize the current knowledge of epidemiology, risk factors, diagnosis and follow-up of coeliac disease and highlight opportunities for future research.

    • Govind K. Makharia
    • , Prashant Singh
    •  & Julio C. Bai

  • Roadmap |

    Coeliac disease is a serious condition and a model disease that can shed light into the mechanisms that underlie autoimmunity and chronic inflammation. This Roadmap summarizes key advances in coeliac disease and provides recommendations from a consensus workshop to address the gaps and opportunities in the pathogenesis, diagnosis and management of coeliac disease, providing a path forward.

    • M. Ines Pinto-Sanchez
    • , Jocelyn A. Silvester
    •  & Elena F. Verdu

  • Review Article |

    A gluten-free diet is currently the only effective treatment for coeliac disease but an increased understanding of disease pathogenesis has led to the identification of several potential therapeutic targets. This Review provides a broad overview of current and emerging therapies for coeliac disease.

    • Laura Kivelä
    • , Alberto Caminero
    •  & Katri Lindfors

  • Year in Review |

    Important studies published in 2020 highlight that coeliac disease is a systemic autoimmune-like disorder with the potential to result in serious long-term health consequences that might also occur outside the gastrointestinal tract. Ultimately, the results of these studies will enable the development of better strategies for the management of coeliac disease.

    • Katri Kaukinen

  • Review Article |

    In this Review, the authors discuss how the gut microbiota might incite food sensitivity. They focus on direct and indirect mechanisms involving microorganisms and how increased understanding of these mechanisms will help the development of therapeutic strategies for food sensitivities.

    • Alberto Caminero
    • , Marlies Meisel
    •  & Elena F. Verdu

  • News & Views |

    New findings show that disease-specific T cells that target gluten in patients with coeliac disease persist for decades. The data highlight a central role for a highly select and stable population of T cells in disease persistence and support the feasibility of diagnostics and therapies targeting these cells.

    • Melinda Y. Hardy
    •  & Jason A. Tye-Din

  • Review Article |

    Intraepithelial T cells (IETs) are a unique collection of T cells located at the epithelial barrier. This Review highlights the role of these cells in gut homeostasis and disease, including coeliac disease and IBD. Targeting of IETs in therapeutic interventions is also discussed.

    • Lisanne Lutter
    • , David P. Hoytema van Konijnenburg
    •  & Femke van Wijk

  • Opinion |

    Traditionally, biopsy has been a mainstay and gold standard for the diagnosis of coeliac disease, but a biopsy-sparing approach has been suggested and adopted for the assessment of children in some countries. Here, the authors outline the current diagnostic methods for coeliac disease, discussing the pros and cons of a no-biopsy approach for both adults and children.

    • Norelle R. Reilly
    • , Steffen Husby
    •  & Peter H. R. Green

  • Research Highlight |

    • Hugh Thomas

  • Review Article |

    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.

    • Jacalyn A. See
    • , Katri Kaukinen
    •  & Joseph A. Murray

  • Review Article |

    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.

    • Tom van Gils
    • , Petula Nijeboer
    •  & Chris J. J. Mulder

  • Review Article |

    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.

    • Knut E. A. Lundin
    •  & Cisca Wijmenga

  • Review Article |

    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.

    • Daniel A. Leffler
    • , Peter H. R. Green
    •  & Alessio Fasano

  • News & Views |

    Coeliac disease is an immune-mediated enteropathy induced by gluten. Generation of gluten-specific CD4+ T cells is necessary but not sufficient to induce overt disease. Now, epithelial stress has been proposed as a distinct factor that synergizes with the anti-gluten adaptive immune response to induce intraepithelial lymphocyte activation and tissue damage.

    • Nadine Cerf-Bensussan
    •  & Bertrand Meresse

  • Review Article |

    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.

    • Imran Aziz
    • , Marios Hadjivassiliou
    •  & David S. Sanders

  • Review Article |

    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.

    • Sabine L. Vriezinga
    • , Joachim J. Schweizer
    •  & M. Luisa Mearin

  • Review Article |

    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.

    • Elena F. Verdu
    • , Heather J. Galipeau
    •  & Bana Jabri

  • Review Article |

    Coeliac disease is a common gastrointestinal disease that can present at any age. Previous diagnosis relied on duodenal biopsy however contemporary techniques of antibody detection and determination of genetic susceptibility using HLA genotyping have improved diagnostic accuracy and reduced the our reliance on biopsy samples. This Review discusses the diagnostic process in children, adolescents and adults in light of the progress that has been made in developing accurate coeliac disease diagnostic tools.

    • Steffen Husby
    •  & Joseph A. Murray

  • News & Views |

    The majority of patients with coeliac disease are undiagnosed, leading to debate about the utility of screening. The heterogeneous clinical presentation, which includes asymptomatic forms, can partially explain the difficulties faced when identifying coeliac disease. Now, Kurppa and colleagues add another element to the debate by strengthening the arguments for general screening.

    • Carlo Catassi
    •  & Alessio Fasano

  • News & Views |

    Patients with noncoeliac gluten sensitivity (NCGS) can experience a range of gastrointestinal and extraintestinal symptoms. A study has now demonstrated that gluten is independently associated with depression in patients with NCGS. NCGS-associated depression might share similar pathophysiological mechanisms to other neurological manifestations observed in gluten-related disorders, such as ataxia and encephalopathy.

    • Imran Aziz
    •  & Marios Hadjivassiliou

  • News & Views |

    Epidemiology studies have shown an ∼1% prevalence of coeliac disease in Europe, North America, the Middle East and South America, but the prevalence in the Asia–Pacific region remains relatively unknown. Now, Makharia et al. have proposed much needed recommendations to help tackle the problem of coeliac disease in this region.

    • Thimmaiah G. Theethira
    •  & Ciarán P. Kelly

  • Year in Review |

    Coeliac disease comprises intolerance against dietary wheat, rye and barley gluten and is one of the most common food-related life-long disorders in Western countries. In 2013, new knowledge of the clinical diversity of coeliac disease and further details about the autoimmune aspects of this disorder have emerged.

    • Katri Kaukinen
    •  & Markku Mäki

  • Review Article |

    Currently, a gluten-free diet is the only approved therapy for coeliac disease. Advances in the understanding of the disease pathogenesis have enabled researchers to develop new treatment strategies. This Review outlines the search for novel future treatment modes and discusses the potential pitfalls of the new research avenues.

    • Katri Kaukinen
    • , Katri Lindfors
    •  & Markku Mäki

  • News & Views |

    A lack of consensus exists on definitions of coeliac disease and related disorders. A paper published in Gut provides guidance to the scientific and clinical community on the terms to be used. However, new nomenclature and different classifications have been proposed in two other publications. Is there a way out of the confusion?

    • Markku Mäki

  • News & Views |

    Obesity can be present in patients with celiac disease. Great concern exists that after diagnosis patients might gain weight and, instead of improving their health with the management of their condition, will substitute the problems of celiac disease for the increased health risks associated with weight gain and obesity.

    • Rajiv Sonti
    •  & Peter H. R. Green

  • News & Views |

    A small-bowel biopsy is currently required in the diagnosis of celiac disease in children. The European Society for Pediatric Gastroenterology, Hepatology and Nutrition has now presented new guidelines for the diagnosis of celiac disease, which indicate that small-bowel biopsy could be avoided in certain cases.

    • Lotta Högberg
    •  & Lars Stenhammar

  • Review Article |

    Celiac disease is an enteropathy associated with gluten sensitivity that affects people of all ages and is a major healthcare problem worldwide. Tack and colleagues discuss the epidemiology and risk factors of celiac disease, draw attention to the broad spectrum of its presenting features and highlight its potential complications. Diagnosis and treatment strategies for uncomplicated and complicated celiac disease are also presented.

    • Greetje J. Tack
    • , Wieke H. M. Verbeek
    •  & Chris J. J. Mulder

  • Review Article |

    Although the prevalence rates of celiac disease tend to be very similar in different Western populations, mortality rates for this disease vary widely. This Review focuses on the mortality rates for the different forms of celiac disease and potential protective factors, such as adherence to a gluten-free diet, early diagnosis and severity of clinical presentation. The authors also propose a hypothesis that links mortality rates to the amount of gluten consumed not only after but also before the diagnosis of celiac disease.

    • Federico Biagi
    •  & Gino R. Corazza

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