Management of celiac disease in daily clinical practice

Published: 5 December 2018
Author(s): Luca Elli, Francesca Ferretti, Stefania Orlando, Maurizio Vecchi, Erika Monguzzi, Leda Roncoroni, Detlef Schuppan

Celiac disease (CD) is the most common autoimmune enteropathy worldwide. In CD, dietary gluten triggers a T cell driven small intestinal inflammation in a subset of genetically predisposed subjects, expressing the HLA DQ2 and/or DQ8 genes on their antigen presenting cells. HLA DQ2/DQ8 can bind gluten peptides after their prior modification by the CD autoantigen, tissue transglutaminase (TG2). This process leads to the activation of gluten reactive T cells, small bowel villous atrophy, crypt hyperplasia and intraepithelial lymphocytosis, the histological hallmarks of CD.