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Therapeutic options for coeliac disease: What else beyond gluten-free diet?

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
February 1, 2020
Giacomo Caio et al. (5 authors)
Journal ArticleReviewHuman Study
Study Details

Study Goal

The researchers aimed to review non-dietary therapies for coeliac disease as alternatives or complements to a gluten-free diet, focusing on six therapeutic strategies.

Results Summary

The study found that a gluten-free diet is the only effective treatment for coeliac disease but is perceived as burdensome, prompting research into alternative therapies. Most developing therapies are in pre-clinical phases, with few in advanced trials, suggesting they may only complement gluten withdrawal rather than replace it.

Population

Genetically predisposed subjects with coeliac disease.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (5)
InterventionDirectionEndpointPopulationDosageImpactClaim #
gluten-free diet
decrease
coeliac disease
genetically predisposed subjects
-
is the only effective treatment available
#1
gluten withdrawal
neutral
patient life
patients
-
perceived as an unsustainable burden
#2
strict gluten-free diet
no change
symptoms
patients
-
some patients can exhibit persistent symptoms despite
#3
non-dietary therapies
neutral
coeliac disease
coeliacs
-
may have a complementary role to gluten withdrawal
#4
non-dietary therapies
decrease
gluten contamination
coeliacs
-
mainly to prevent inadvertent gluten contamination
#5
Abstract

Coeliac disease is a chronic and systemic autoimmune condition triggered by gluten ingestion in genetically predisposed subjects. Currently, the only effective treatment available is a strict, lifelong gluten-free diet. However, patients perceive gluten withdrawal as an unsustainable burden in their life and some of them can exhibit persistent symptoms despite a strict diet. Thus, gluten-free diet represents a challenge, leading scientists to look for alternative or complementary treatments. This review will focus on non-dietary therapies for coeliac disease highlighting six therapeutic strategies: (1) decreasing gluten immunogenic content before it reaches the intestine; (2) sequestering gluten in the gut lumen before absorption; (3) blocking the passage of gluten through a leaky intestinal barrier; (4) preventing the enhancement of immune response against gliadin; (5) dampening the downstream immune activation; (6) inducing immune tolerance to gluten. Most developing therapies are only in the pre-clinical phase with only a few being tested in phase 2b or 3 trials. Although new approaches raise the hope for coeliacs giving them a chance to come back to gluten, for the time being a cautionary appraisal of new therapies suggests that they may have a complementary role to gluten withdrawal, mainly to prevent inadvertent gluten contamination.

Medical Subject Headings (MeSH)
Celiac DiseaseDiet, Gluten-FreeGliadinGlutensHumansImmunosuppression TherapyImmunotherapyIntestinal AbsorptionRandomized Controlled Trials as Topic
Study Links
Quality Scores
SafetyNot Assessed
Efficacy85/10
Quality75/10
Citation Metrics
Total Citations26
Citations/Year5.2
Relative Citation Ratio2.03
NIH Percentile75%
Research Impact Scores
APT Score0.75
Weight Score2.38
Normalized Score0.69
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