Celiac Disease

Association of celiac disease and myocardial infarction: a systematic review and meta-analysis.

Sharma N, Shabil M, Khatib MN, Singh RP, Singh MP, Bushi G · BMC cardiovascular disorders · 2024

Celiac disease (CD) is an autoimmune disorder characterized by gluten intolerance, primarily affecting the gastrointestinal system but potentially influencing cardiovascular health. Emerging evidence suggests an association between CD and myocardial infarction (MI), though studies have produced inconsistent results. This study aimed to systematically review and conduct a meta-analysis of existing literature to quantify the risk of MI in individuals diagnosed with CD. A comprehensive literature search was performed across PubMed, Embase, and Web of Science up to August 2024. Studies were included if they investigated the association between CD and MI in adult populations and provided relevant effect estimates. Data from eligible studies were extracted, and a random-effects meta-analysis was conducted to calculate pooled hazard ratios (HRs) and odds ratios (ORs), along with an assessment of heterogeneity. Statistical analysis has been performed by R software (V 4.4). A total of 8 studi

Meta-Analysis and Systematic Review of HLA DQ2/DQ8 in Adults with Celiac Disease.

Aboulaghras S, Piancatelli D, Taghzouti K, Balahbib A, Alshahrani MM, Al Awadh AA · International journal of molecular sciences · 2023

Although people with human leukocyte antigens (HLA) DQ2 and/or DQ8 are more likely to develop celiac disease (CD), the condition cannot be fully explained by this genetic predisposition alone. Multiple, as yet unidentified, factors contribute to the genesis of CD, including genetics, the environment, and the immune system. In order to provide insight into a prospective possibility and an expanded screening technique, we aim to undertake a comprehensive and meta-analytical study of the assessment and distribution of HLA class II (HLA-DQ2/DQ8) in adult CD patients. A systematic review was conducted using an electronic search of databases (PubMed, Google Scholar, Embase, and Direct Science) from January 2004 to February 2022. DQ2/DQ2 homozygotes have the highest risk of developing CD. DQ2/DQ8 typing is an effective test to exclude CD from the differential diagnosis of a patient with CD symptoms. Although other non-HLA genes have been associated with CD, they are rarely considered at diagn

Pancreatic Cancer in Celiac Disease Patients-A Systematic Review and Meta-Analysis.

Gromny I, Neubauer K · International journal of environmental research and public health · 2023 · n=941

Background: Celiac disease (CD) is an autoimmune enteropathy affecting approximately 1% of the population and is associated with an increased risk of enteropathy-associated T-cell lymphoma and small bowel adenocarcinoma, whereas the association between CD and other malignancies is unclear. Since pancreatic cancer (PC) remains one of the most lethal neoplasms and its incidence is increasing despite numerous ongoing research on diagnostic biomarkers and novel therapies, we aimed to investigate whether CD has an impact on the risk of PC. Material and Methods: We performed a systematic review of the literature published from January 2000 to March 2022 in two databases: Web of Science and Scopus and a meta-analysis of eligible studies. Results: Our search identified eight publications included in the systematic review. A total of five studies involving 47,941 patients, including 6399 CD patients with malignancies and 1231 PC cases were included in the meta-analysis and 221 cases of PC in CD

IgE-Dependent Allergy in Patients with Celiac Disease: A Systematic Review.

Majsiak E, Choina M, Knyziak-Mędrzycka I, Bierła JB, Janeczek K, Wykrota J · Nutrients · 2023 · n=63

In order to answer the question if an IgE-mediated allergy (A-IgE) may occur in subjects with celiac disease (CD), a systematic review was performed of available publications collected in the United States National Institute for Biotechnology Information/National Institutes of Health/National Library of Medicine/PubMed database up to 28 December 2022, with the use of the following keywords "allergy&celiac/coeliac", "sensitization&celiac/coeliac", and "anaphylaxis&celiac/coeliac" compared in the form of a conjunction. In total, the search returned 2013 publications from these keywords in any section of the article. As numerous review articles included the above-mentioned entries in the abstract, we decided to focus on the publications with the entries only in the title (n = 63). After rejecting studies unrelated to the topic, narrative reviews, book chapters, conference abstracts, symposium reports, letters to the editor, or non-English articles, 18 publications (6 observati

Celiac disease and COVID-19 in adults: A systematic review.

Amirian P, Zarpoosh M, Moradi S, Jalili C · PloS one · 2023

Celiac disease (CD) is an autoimmune disease affecting around 1.4% of the total human population. Local and systemic manifestations are described in CD. Viral infections seem to trigger CD or even have a worse outcome in CD patients. The evidence on the relationship between CD and coronavirus disease (COVID-19) is limited. To evaluate existing evidence on the association between CD and COVID-19, we conducted the current systematic review. We systematically searched Pubmed, Scopus, and Embase databases to find articles that reported risks or outcomes of COVID-19 in CD patients. Papers in any language published up to November 17, 2022, were evaluated for possible inclusion. The results were analyzed qualitatively. This study is registered with PROSPERO(CRD42022327380). We identified 509 studies by searching databases; 14 reported data on the risk or outcome of COVID-19 in CD patients and were eligible for qualitative synthesis. We found that the relative risk of acquiring COVID-19 in C

Dietary recommendations of the French Society for Rheumatology for patients with chronic inflammatory rheumatic diseases.

Daien C, Czernichow S, Letarouilly JG, Nguyen Y, Sanchez P, Sigaux J · Joint bone spine · 2022

This article presents the 1st set of dietary recommendations of the French Society for Rheumatology for patients suffering from chronic inflammatory rheumatic diseases (IRD) made by a working group consisting of 12 rheumatology experts, 3 physician nutrition specialists, 1 internal medicine specialist, 1 registered dietician and 3 representatives from patient associations. This group relied on a systematic literature review and on expert opinions, while taking into consideration not only the joint effects of diet in IRD but also the extra-articular ones. Eight general principles and nine recommendations were established. The general principles emphasize that nutritional advice is not a substitute for pharmacological treatment of IRD and that it is an integral part of the patients' overall care, which could help the patient actively participate in their care. The recommendations propose supporting weight loss in subjects who are overweight or obese, a Mediterranean-type diet and supplem

Italian guidelines for the diagnosis and treatment of functional dyspepsia - joint consensus from the Italian societies of gastroenterology and endoscopy (SIGE), Neurogastroenterology and motility (SINGEM), hospital gastroenterologists and endoscopists (AIGO), digestive endoscopy (SIED) and general medicine (SIMG).

Sarnelli G, Pesce M, Barbara G, de Bortoli N, Sario AD, Esposito G · Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver · 2025

Functional dyspepsia (FD) is one of the most prevalent disorders of the upper gastrointestinal tract. Despite its broad prevalence, FD diagnosis and treatment are still not well standardized. The aim of this project was to outline an Italian Guideline to define a standardized approach in terms of diagnostic and therapeutic work-up to support both general practitioners and specialists in Gastroenterology. To address this issue, experts from 5 Italian Societies conducted a Delphi consensus process, which included a review of the current literature and voting process on 24 key statements. Recommendations and quality of evidence were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Consensus for each statement was defined as ≥ 80 % agreement. DIAGNOSTIC APPROACH: The panel reached consensus on defining FD and its main symptoms and dividing this entity into two different subgroups: the epigastric pain syndrome (EPS) and the pos

AGA Clinical Practice Update on GI Manifestations and Autonomic or Immune Dysfunction in Hypermobile Ehlers-Danlos Syndrome: Expert Review.

Aziz Q, Harris LA, Goodman BP, Simrén M, Shin A · Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2025

The purpose of this Clinical Practice Update Expert Review is to describe key principles in the evaluation and management of patients with disorders of gut-brain interaction (DGBI) and hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorders (HSDs) with coexisting postural orthostatic tachycardia syndrome (POTS) and/or mast cell activation syndrome (MCAS). This expert review was commissioned and approved by the American Gastroenterological Association (AGA) Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. These Best Practice Advice statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these Best Pra

Updated joint ESPGHAN/NASPGHAN guidelines for management of Helicobacter pylori infection in children and adolescents (2023).

Homan M, Jones NL, Bontems P, Carroll MW, Czinn SJ, Gold BD · Journal of pediatric gastroenterology and nutrition · 2024

Evolving epidemiological data and increasing antibiotic resistance mandate an update of the European and North American Societies of Pediatric Gastroenterology, Hepatology and Nutrition guidelines. Certainty of evidence and strength of recommendations were rated by experts according to the Grading of Recommendation Assessment, Development, and Evaluation approach. PICO (patient population, intervention, comparator, and outcome) questions were developed and voted on by the group. Recommendations were formulated using the Evidence to Decision framework. The current literature supports many of the previous recommendations and several new recommendations. Invasive testing with strain antimicrobial susceptibility analysis is recommended for the diagnosis and selection of eradication therapy for H. pylori infection. Molecular methods are acceptable for detection of infection and of antibiotic resistance in gastric biopsy specimens. Reliable, noninvasive tests can be used as a screenin

Effect of gluten and wheat on symptoms and behaviours in adults with irritable bowel syndrome: a single-centre, randomised, double-blind, sham-controlled crossover trial.

Seiler CL, Rueda GH, Miranda PM, Nardelli A, Borojevic R, Hann A · The lancet. Gastroenterology & hepatology · 2025 · n=15

Many patients with irritable bowel syndrome (IBS) believe gluten or wheat triggers their symptoms. We compared symptomatic responses to wheat and gluten with gluten-free sham challenge in patients with IBS who previously perceived benefit from a gluten-free diet. We conducted this randomised, double-blind, sham-controlled crossover study at McMaster University Medical Centre, ON, Canada. Eligible participants were adults aged 18 years or older who met Rome IV criteria for IBS and had previously self-reported improvement on a gluten-free diet, which was implemented for at least 3 weeks before enrolment. Eligible participants were randomly assigned (1:1:1:1:1:1) to receive one of six sequences of wheat, gluten, and sham (containing gluten and wheat free flour) in three periods of 7 days, separated by 14-day washout periods. Randomisation was done using the randomizeBE package in R and the cereal bars were designed to have the same appearance, taste, and smell to maintain blinding. The p

Transcriptomic analysis of intestine following administration of a transglutaminase 2 inhibitor to prevent gluten-induced intestinal damage in celiac disease.

Dotsenko V, Tewes B, Hils M, Pasternack R, Isola J, Taavela J · Nature immunology · 2024

Transglutaminase 2 (TG2) plays a pivotal role in the pathogenesis of celiac disease (CeD) by deamidating dietary gluten peptides, which facilitates antigenic presentation and a strong anti-gluten T cell response. Here, we elucidate the molecular mechanisms underlying the efficacy of the TG2 inhibitor ZED1227 by performing transcriptional analysis of duodenal biopsies from individuals with CeD on a long-term gluten-free diet before and after a 6-week gluten challenge combined with 100 mg per day ZED1227 or placebo. At the transcriptome level, orally administered ZED1227 effectively prevented gluten-induced intestinal damage and inflammation, providing molecular-level evidence that TG2 inhibition is an effective strategy for treating CeD. ZED1227 treatment preserved transcriptome signatures associated with mucosal morphology, inflammation, cell differentiation and nutrient absorption to the level of the gluten-free diet group. Nearly half of the gluten-induced gene expression chan

Gastrointestinal Food Allergies and Intolerances.

Hon E, Gupta SK · Gastroenterology clinics of North America · 2021

Adverse reactions to food include immune-mediated food allergies, celiac disease, and nonimmune-mediated food intolerances. Differentiating between these many disorders is important to guide us toward appropriate testing and management. Double-blind placebo-controlled food challenges are the gold standard for food allergy diagnosis but are difficult and time-consuming. In place of this, strong clinical history, other supportive tests, and oral food challenges are helpful. Some commonly available tests for food allergy and intolerances lack sufficient evidence for efficacy. Food intolerance diagnosis is largely based on history and supported by symptom improvement with appropriate dietary manipulation.

Coeliac disease and the intestinal barrier: mechanisms of disruption and strategies for restoration.

Damianos JA, Bledsoe A, Camilleri M, Murray JA · Gut · 2026

Coeliac disease is characterised by immune-mediated damage to the small intestine in response to dietary gluten in genetically predisposed individuals. Increased intestinal permeability is a central component to its pathophysiology. This review explores the evidence for increased permeability in coeliac disease and the underlying mechanisms, including the roles of zonulin, inflammatory cytokines, microbial alterations and immune responses to gliadin peptides. We also review comprehensively the therapies targeting barrier integrity and normalising intestinal permeability, including particular diets and supplements, and experimental and improved medications including larazotide acetate and IMU-856. Finally, we highlight the need for reliable biomarkers for evaluating increased permeability in coeliac disease and advocate for further research on therapies which normalise barrier function, particularly as a strategy to maintain remission.

Increased Serum Levels of Dickkopf-1 and Sclerostin as WNT Signaling Pathway Inhibitors in Celiac Disease Patients.

Al-Ani MNT, Yahya SKT, Dastorani M, Mirkarimi H, Besharat S, Jazi MS · Immunity, inflammation and disease · 2026

Celiac disease (CD) is an autoimmune enteropathy. The WNT signaling pathway acts in adult intestinal epithelium maintenance. To evaluate the level of two WNT antagonists, including dikkopf-1 (Dkk-1) and sclerostin, in CD patients compared to controls. A total of 43 cases and 45 controls were enrolled in this case-control study. The serum levels of Dkk-1, sclerostin, citrulline, and parathyroid hormone (PTH) were measured using the ELISA method. Moreover, the levels of vitamin D3 were measured using the HPLC method. Our findings illustrated an elevation of both WNT antagonists (Dkk-1, p < 0.0001 and sclerostin, p = 0.002) in CD patients compared to controls. Moreover, the levels of PTH (p < 0.0001) and Ca (p = 0.009) were higher in CD patients. The level of citrullin was directly correlated with sclerostin (R = 0.71), PTH (R = 0.53), and Dkk-1 (R = 0.29). ROC curve analysis indicat

Chronic, Noninfectious Diarrhea: A Review.

Singh P, Lee A, Sheth NM, Chey WD · JAMA · 2026

Chronic diarrhea is defined as loose or watery stools lasting longer than 4 weeks and affects approximately 6% to 7% of adults in the US. More than 90% of patients with chronic diarrhea have a noninfectious etiology. The most common causes of chronic, noninfectious diarrhea are irritable bowel syndrome with diarrhea (IBS-D) and functional diarrhea. IBS-D typically presents with recurrent abdominal pain relieved or worsened after defecation. Functional diarrhea is a condition in which more than 25% of bowel movements in the preceding 3 months are loose or watery, but it is not associated with significant abdominal pain. Chronic diarrhea due to a small-bowel source, such as celiac disease or small intestinal bacterial overgrowth, is typically associated with large-volume diarrhea and weight loss, with or without steatorrhea. Celiac disease is an autoimmune condition defined by enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals, and small intest

Long term impact of formula choice in children with cow milk protein allergy: 6-year follow-up of the Atopic March Cohort Study.

Nocerino R, Bedogni G, Carucci L, Aquilone G, Oglio F, Coppola S · Clinical nutrition (Edinburgh, Scotland) · 2025 · n=313

Cow's milk protein allergy (CMPA) is a significant health issue in the pediatric age, carrying lifelong health implications. To compare the impact of different formulas on the occurrence of other atopic manifestations (AMs), autoimmune disorders (ADs) and the time of immune tolerance acquisition in a population of children with immunoglobulin E (IgE)-mediated cow CMPA. In a 72-month prospective cohort study the occurrence of other AMs (i.e., eczema, urticaria, asthma, and rhinoconjunctivitis), ADs (i.e., celiac disease, thyroiditis, type 1 diabetes, inflammatory bowel diseases, idiopathic juvenile arthritis) and the time of immune tolerance acquisition were comparatively evaluated in IgE-mediated CMPA children treated with different formulas: extensively hydrolyzed casein formula containing the probiotic L. rhamnosus G (EHCF + LGG), rice hydrolyzed formula (RHF), soy formula (SF), extensively hydrolyzed whey formula (EHWF), or amino-acid based formula (AAF). 313 subjec

A20's linear ubiquitin-binding motif restrains pathogenic activation of Th17 cells and IL-22-driven enteritis.

Bowman CJ, Stibor DM, Sun X, Lenci N, Shimizu H, Yamashita EF · The Journal of clinical investigation · 2025

A20, encoded by the TNFAIP3 gene, is a protein linked to Crohn's disease and celiac disease in humans. We now find that mice expressing point mutations in A20's M1-ubiquitin-binding zinc finger 7 (ZF7) motif spontaneously develop proximal enteritis that requires both luminal microbes and T cells. Cellular and transcriptomic profiling reveals expansion of Th17 cells and exuberant expression of IL-17A and IL-22 in intestinal lamina propria of A20ZF7 mice. While deletion of IL-17A from A20ZF7/ZF7 mice exacerbates enteritis, deletion of IL-22 abrogates intestinal epithelial cell hyperproliferation, barrier dysfunction, and alarmin expression. Colonization of adult germ-free mice with microbiota from adult WT specific pathogen-free mice drives duodenal IL-22 expression and duodenitis. A20ZF7/ZF7 Th17 cells autonomously express more RORγt and IL-22 after differentiation in vitro. ATAC sequencing identified an enhancer region upstream of the Il22 gene, and this enhancer demonstrated inc

Effect of oral cholecalciferol in a murine model of celiac disease: A dose ranging study.

Trasciatti S, Piras F, Bonaretti S, Marini S, Nencioni S, Biasci E · The Journal of steroid biochemistry and molecular biology · 2022

Previous studies have shown a relationship between vitamin D and celiac disease (CD), however little evidence is available examining the direct effects of vitamin D on pathological features of this disease. In this study we evaluated the effect of oral administration of different doses of native vitamin D3 (cholecalciferol) in enteropathic mice. Female non-obese diabetic (NOD)/ShiLt.J mice were fed standard or gluten-free diet and administered gliadin (5 μg/kg) to induce a celiac pathology. Healthy control (gluten-free diet, without gliadin) and control for pathology (standard diet, with gliadin) were administered olive oil. All other experimental groups received gliadin and standard diet plus oral cholecalciferol (5, 10, 20, 50 and 130 μg/kg). Serum levels of 25(OH)D3, calcium and zonulin and expression of vitamin D receptor (VDR), CD3 and zonula occludens-1 (ZO-1) by immunohistochemistry as well as intestinal histological and histomorphometric analyses were unde

Celiac Disease

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Part of the NIH, NIDDK offers in-depth, evidence-based information about celiac disease for patients and health professionals. It covers symptoms, diagnosis, treatment, and dietary management.

Coeliac disease

NHS

This NHS page provides an overview of coeliac disease, including symptoms, diagnosis, treatment (primarily a gluten-free diet), and advice on living with the condition. It serves as a reliable source of public health information in the UK.

Coeliac disease - Treatment

NHS

This NHS page provides an overview of coeliac disease treatment, focusing on the gluten-free diet and addressing common nutritional deficiencies. It mentions the importance of vitamin and mineral supplements, including vitamin D, for individuals with celiac disease.

Osteoporosis In Non-Celiac Wheat Sensitivity Patients

n=270 · NCT02421783 · COMPLETED · COMPLETED

Non-celiac gluten sensitivity (NCGS) or 'wheat sensitivity' (NCWS) is included in the spectrum of gluten-related disorders. No data are available on the prevalence of low bone mass density (BMD) in NCWS. Our study aims to evaluate the prevalence of low BMD in NCWS patients and search for correlations with other clinical characteristics. This prospective observation study will include 90 NCWS patients with irritable bowel syndrome (IBS)-like symptoms, 90 IBS and 90 celiac controls. Patients will be recruited at the Internal Medicine and at the Gastroenterology Units of the University of Palermo. Elimination diet and double-blind placebo controlled (DBPC) wheat challenge proved the NCWS diagnosis. All subjects underwent BMD assessment by Dual Energy X-Ray Absorptiometry (DXA), duodenal histology, Human Leukocyte Antigen (HLA) DQ typing, body mass index (BMI) evaluation and assessment for daily calcium intake.

Restoration of Impaired Microbiota-mediated Aryl Hydrocarbon Receptor Signaling in Celiac Disease by Oral Tryptophan Supplementation: an Exploratory, Pilot Trial

n=50 · NCT05576038 · RECRUITING · RECRUITING

This is a prospective, randomized, double-blind, placebo-controlled exploratory trial to evaluate the effect of L-tryptophan supplementation on celiac-related symptoms in individuals who have biopsy-confirmed celiac disease (CeD) and symptoms non-responsive to a gluten-free diet (GFD). Fifty participants, aged 18 to 75 years, who self-report persistent CeD-related symptoms despite taking a GFD for more than 1 year and who score \> 40 on the Celiac Symptom Index (CSI) will be randomized to receive L-tryptophan or placebo for 3 weeks.

Genetic and Biological Background and Follow-up of Different Phenotypes of Coeliac Disease

n=3500 · NCT05597904 · RECRUITING · RECRUITING

The main purpose of this study is to investigate genetic, serological, immunological and microbiata diversities between different coeliac disease phenotypes and to discover applicable prognostic markers for specific phenotypes.

TRIP Database: Celiac Disease

TRIP Database

The TRIP Database is a clinical search engine that allows clinicians to quickly find high-quality research evidence to support their practice. Searching for 'Celiac Disease' yields various evidence types, including guidelines, systematic reviews, and primary research.

Cochrane Library: Celiac Disease

Cochrane

The Cochrane Library provides systematic reviews and meta-analyses on various healthcare interventions for celiac disease. It serves as a valuable resource for evidence-based healthcare decisions.