Celiac Disease: A Disorder Emerging from Antiquity, Its Evolving Classification and Risk, and Potential New Treatment Paradigms

Celiac disease is a chronic genetically based gluten-sensitive immune-mediated enteropathic process primarily affecting the small intestinal mucosa. The disorder classically presents with diarrhea and weight loss; however, more recently, it has been characterized by subclinical occult or latent disease associated with few or no intestinal symptoms. Diagnosis depends on the detection of typical histopathological biopsy changes followed by a gluten-free diet response. A broad range of clinical disorders may mimic celiac disease, along with a wide range of drugs and other therapeutic agents. Recent and intriguing archeological data, largely from the Gobleki Tepe region of the Fertile Crescent, indicate that celiac disease probably emerged as humans transitioned from hunter-gatherer groups to societies dependent on agriculture to secure a stable food supply. Longitudinal studies performed over several decades have suggested that changes in the prevalence of the disease, even apparent epidemic disease, may be due to superimposed or novel environmental factors that may precipitate its appearance. Recent therapeutic approaches are being explored that may supplement, rather than replace, gluten-free diet therapy and permit more nutritional options for future management.

Doença celíaca / Celiac disease

A doença celíaca (DC) é uma enteropatia caracterizada pela intolerância permanente ao glúten desencadeada por mecanismos autoimunes nos indivíduos geneticamente predispostos. A DC com seu quadro clínico típico e principalmente atípico tem se mostrado mais frequente do que se imaginava. Seu diagnóstico é baseado em suspeita clínica, exames sorológicos e biópsia intestinal. Devido à evolução dos marcadoressorológicos e revisão dos critérios diagnósticos, discute-se sobre a real necessidade da realização da biópsia intestinal em casos selecionados. O tratamento da DC continua sendo a dieta isenta de glúten.

Celiac disease (CD) is an enteropathy characterized by permanent intolerance to gluten triggered by autoimmune mechanisms in genetically predisposed individuals. The frequency of CD, with its typical clinical condition and mainly atypical, has been higher than expected. Its diagnosis is based on clinical suspicion, serologic tests, and intestinal biopsy. The evolution of the knowledge about serological markers and revision of thediagnostic criteria prompts questions about the real need of intestinal biopsy in selected cases. The treatment of CD remains the gluten-free diet.