Celiac disease (CD) is regarded as the most common autoimmune enteropathy in western countries. Epidemiological studies indicate that approximately 1:100 individuals may present with histologically proven CD. CD develops in genetically predisposed subjects after gluten ingestion. It usually subsides after gluten is withdrawn from their diet. Gluten is the only known environmental factor that affects the progression/regression of the intestinal villous atrophy, which is the hallmark of this disease. CD generally follows a benign course after gluten elimination. However, it is also associated with the development of other autoimmune disorders or of intestinal malignancies. The issue of whether such complications, sometimes of significant clinical and prognostic impact, are or are not the result of ongoing gluten ingestion, is an important one that has been investigated over the recent years with conflicting results. In terms of practical implications, the presence of a positive correlation between gluten intake and the development of severe complications would lead to the need for early diagnosis and mass screening. The lack of such correlation would instead suggest a less aggressive diagnostic strategy. This review aims at critically summarizing the evidence supporting either hypothesis.
*Centre for the Prevention and Diagnosis of Celiac Disease/Gastroenterology II, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan
†Department of Translational Medicine, Section of Pediatrics University of Naples Federico II, Naples, Italy
‡Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Celiac Disease Center, University of Chicago, Chicago, IL
The authors declare that they have nothing to disclose.
Reprints: Stefano Guandalini, MD, Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Celiac Disease Center, University of Chicago, 5841S. Maryland Avenue, Chicago, IL (e-mail: firstname.lastname@example.org).