April 2008: Advances in Celiac Disease and Gluten-Free Diet

Celiac disease is becoming an increasingly recognized autoimmune enteropathy caused by a permanent intolerance to gluten. Once thought to be a rare disease of childhood characterized by diarrhea, celiac disease is actually a multisystemic disorder that occurs as a result of an immune response to ingested gluten in genetically predisposed individuals. Approximately 97% of individuals with celiac disease have genetic markers on their chromosomes. Screening studies have revealed that celiac disease is most common in asymptomatic adults in the United States. Prevalence of celiac disease has increased sharply in recent years because of better recognition of the disease and its associated disorders, but there is no single test that can definitively diagnose or exclude celiac disease in every individual.

Although considerable scientific progress has been made in understanding celiac disease and in preventing or curing its manifestations, a strict gluten-free diet is the only treatment for celiac disease to date. All foods and medications containing gluten from wheat, rye, and barley, and their derivatives are eliminated, as even small quantities of gluten may be harmful. Complete removal of gluten from the diet in a patient with celiac disease will result in symptomatic, serologic, and histologic remission in the majority of patients, and 70% of patients report an improvement in symptoms within 2 weeks of initiating the gluten-free diet. Early diagnosis and treatment, together with regular follow-up visits with a dietitian, are necessary to ensure nutritional adequacy and to prevent malnutrition while adhering to the gluten-free diet for life.

The purpose of the review was to provide clinicians with current updated information about celiac disease, its diverse clinical presentation and increased prevalence, the complex pathophysiology and strong genetic predisposition to celiac disease, and its diagnosis. This review focuses in detail on the gluten-free diet and the importance of intense expert dietary counseling for all patients with celiac disease.

Studies have found that gluten contamination in gluten-free products cannot totally be avoided. Experts continue to work toward an agreeable safe threshold for gluten contamination in gluten-free products. Recent advances in the gluten-free diet include food allergen labeling as well as the US Food and Drug Administration's proposed definition of the food labeling term gluten-free. Currently, in the United States, there is no federal regulation that defines the term gluten-free used in the labeling of foods.

Quality of life for patients with celiac disease could potentially be improved if a treatment was available that would allow patients to consume gluten, even in small amounts or over a short period of time. Effective treatments for celiac disease, other than dietary restrictions, are being developed. But currently a gluten-free diet is the only treatment recommended for those with celiac disease. The gluten-free diet is complex and patients need comprehensive nutrition education from a skilled dietitian.


JADA review article:
Niewinski, M. (2008). Advances in celiac disease and gluten-free diet. Journal of the American Dietetic Association, 108, 661-672.