Narrative Review: Celiac Disease: Understanding a Complex Autoimmune Disorder

Columbia University, New York, New York, United States
Annals of internal medicine (Impact Factor: 17.81). 03/2005; 142(4):289-98. DOI: 10.7326/0003-4819-142-4-200502150-00011
Source: PubMed


Celiac disease is a common autoimmune disorder that has genetic, environmental, and immunologic components. It is characterized by an immune response to ingested wheat gluten and related proteins of rye and barley that leads to inflammation, villous atrophy, and crypt hyperplasia in the intestine. The disease is closely associated with genes that code for human leukocyte antigens DQ2 and DQ8. Transglutaminase 2 appears to be an important component of the disease, both as a deamidating enzyme that can enhance the immunostimulatory effect of gluten and as a target autoantigen in the immune response. Sensitive and specific serologic tests, including those for anti-transglutaminase antibody, are facilitating fast and noninvasive screening for celiac disease. Thus, they are contributing to a more accurate estimate of the prevalence of the disease and its association with other disorders. Celiac disease is associated with increased rates of anemia, osteoporosis, cancer, neurologic deficits, and additional autoimmune disorders. A gluten-free diet is the mainstay of safe and effective treatment of celiac disease, although its effect on some of the extraintestinal manifestations of the disease remains to be determined.

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    • "This special property of wheat flour makes it suitable for the production of various bakery products . Ingestion of wheat gluten and related proteins from barley and rye , however , has been identified to cause celiac disease in humans , an autoimmune disorder characterized by inflammation , villous atrophy , and crypt hyperplasia in the small intestine ( Alaedini and Green 2005 ) . Therefore , in the past decades much research attention has been paid to the development of high - quality gluten - free cereal products by replacing wheat , barley , and rye flour with other cereal flours ( e . "
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    ABSTRACT: Humans have a history of cultivating cereal crops and utilizing their grains to prepare various types of food for thousands of years. The most popular cereal products available in the market include bread, cookies/biscuits, cakes, pasta, noodles, and extruded snacks and breakfast cereals. They are an important part of our daily diets and provide energy and essential nutrients for human health. Cereal grains contain starch and protein as the major components and lipid, non-starch carbohydrates, phytic acid, vitamins, and minerals as the minor components. Physical interactions and chemical reactions occur between these constituents during the processing and storage of cereal products, which determine their quality, storage stability, and nutritional value. With an increasing population of people suffering from celiac disease, diabetes, obesity, and other metabolic syndrome, there are opportunities and challenges for the food industry to develop healthier cereal products through utilizing novel ingredients and improving processing technologies. This book chapter offers a good review of chemical compositions of different cereal grains, processing technologies applied to produce various cereal foods, and future trends of research and product development in this area.
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    • "However, most cases are believed to be undiagnosed. The basis of the disorder is an inflammation of the upper small intestine villi after ingesting gluten proteins from wheat, rye, barley, and possibly oats (Alaedini and Green, 2005). "
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    ABSTRACT: Commercially milled food-grade sorghum flour was subjected to ozone at the rate of 0.06 L/min for 15, 30, and 45 min. The pH of ozone-treated flour decreased as exposure time increased. The L* (lightness) values of sorghum flour significantly increased (p < 0.05), while the b* (yellowness) values significantly decreased as ozone exposure time increased. Peak viscosity significantly increased as time of ozonation increased from 0 to 45 min. Results showed that gluten-free cake volume significantly increased as ozonation time increased. Additionally, longer ozonation exposure times increased cells per slice area, lightness, and slice brightness values in gluten-free cakes while reducing crumb firmness. Despite improving lightness and slice brightness values, ozonation did not significantly increase the specific volume of gluten-free batter-based bread. While ozonation improved the volume and texture in cakes, it did not have the same positive effects on gluten-free bread. Bread made from ozonated sorghum flour had an open ragged structure with equivalent volume to the control flour. In both applications, the increased brightness and lightness values due to ozone exposure is recommended to increase the acceptability of sorghum products. © The Author(s) 2014 Reprints and permissions:
    Full-text · Article · Nov 2014 · Food Science and Technology International
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    • "While some patients with cerebellar ataxia are reported to have low vitamin E levels, neurological manifestations may even arise without enteropathy [16] [17]. Consequently, immune mechanisms, as opposed to malabsorption, are suspected to be involved in the pathogenesis of these disorders [7]. This hypothesis is supported by evidence of lymphocytic infiltration in the central and peripheral nervous systems [18], as well as by the presence of serum antineuronal antibodies [19], in CD patients with neurological complications. "
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    ABSTRACT: Although a range of neurological and psychiatric disorders are widely reported to be associated with coeliac patients, their pathogenesis remains unclear. Some such disorders are believed to be secondary to vitamin deficiency due to malabsorption, others to immune mechanisms. We hypothesise that hyperhomocysteinemia might, by damaging the blood-brain barrier, expose neuronal tissue to all neuro-irritative metabolites, such as homocysteine itself, a neurotoxic excitatory and proconvulsant amino acid. Neurons respond to these stimuli through hyperexcitability, thereby predisposing subjects to neurological disorders such as epilepsy and headache. Furthermore, persisting endothelial damage may cause blood extravasation and subsequent deposition of calcium salts. We suggest that this might be the pathogenesis of the CEC syndrome, which is characterized by the association of coeliac disease, epilepsy and cerebral calcifications. Indeed, homocysteine plays a well-known role in cardiovascular endothelial dysfunction, with high serum and cerebrospinal fluid levels often being reported in coeliac patients. Moreover, data in the literature show a strong, growing association of homocysteine with epilepsy and migraine in non-coeliac subjects.
    Full-text · Article · Jul 2013 · Medical Hypotheses
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