Celiac disease and non-celiac gluten sensitivity

• Published in: BMJ (Online) Vol. 351; p. h4347
• Main Authors: Lebwohl, Benjamin, Ludvigsson, Jonas F, Green, Peter H R
• Format: Journal Article Book Review
• Language: English
• Published: England British Medical Journal Publishing Group 05-10-2015; BMJ Publishing Group LTD; BMJ Publishing Group Ltd
• Series: State of the Art Review
• Subjects: Age of Onset; Celiac disease; Celiac Disease - diagnosis; Celiac Disease - diet therapy; Celiac Disease - epidemiology; Clinical Review; Diet, Gluten-Free; Environmental Exposure; Genetic Predisposition to Disease; Glutens - immunology; Humans; Intestinal Mucosa - immunology; Medicin och hälsovetenskap; Prevalence; Quality of Life; Risk Factors; STATE OF THE ART REVIEW
• ISSN: 0959-8138; 1756-1833; 1756-1833
• DOI: 10.1136/bmj.h4347

Celiac disease is a multisystem immune based disorder that is triggered by the ingestion of gluten in genetically susceptible individuals. The prevalence of celiac disease has risen in recent decades and is currently about 1% in most Western populations. The reason for this rise is unknown, although environmental factors related to the hygiene hypothesis are suspected. The pathophysiology of celiac disease involves both the innate and adaptive immune response to dietary gluten. Clinical features are diverse and include gastrointestinal symptoms, metabolic bone disease, infertility, and many other manifestations. Although a gluten-free diet is effective in most patients, this diet can be burdensome and can limit quality of life; consequently, non-dietary therapies are at various stages of development. This review also covers non-celiac gluten sensitivity. The pathophysiology of this clinical phenotype is poorly understood, but it is a cause of increasing interest in gluten-free diets in the general population.