Therapeutic options for coeliac disease: What else beyond gluten-free diet?
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
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
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 |
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.