Editorial
Copyright ©2011 Baishideng Publishing Group Co.
World J Gastroenterol. Aug 28, 2011; 17(32): 3665-3671
Published online Aug 28, 2011. doi: 10.3748/wjg.v17.i32.3665
Table 1 The ages of celiac disease
AgeDateClinicsDiagnosisPathogenesis
The origins-1888At the borders of the fertile crescent
The age of steatorrhea Fat in stools and diet as a treatment1888-1952Intestinal syndromeFatty stoolsChronic indigestion
Diet attempts
The age of gluten. An intolerance to a protein1952-1965Gut disease Celiac crisisCrosby-kugler capsule assisted diagnosis Acid fat measure in feces allows diet follow-up A very rare diseaseWheat, barley and rye gluten is guilty Flat mucosa is responsible for a malabsorption syndrome The “three biopsies” approach suggested that gluten susceptibility in celiacs is a permanent condition
The age of AGA. CD as an immune disorder1965-AGA assay allowed characterization of the atypical form or even the diagnosis of asymptomatic subjects founded the celiac societyAGA Three biopsiesCD is an immune disorder, like a chronic infection by gluten Association to specific HLA variants
The Age of AEA. CD is associated with autoimmunity.1973-Definition of silent and latent CD The risk of autoimmunity in CD is, at least in part, related to the duration of exposure to glutenAEA Three biopsies CD screening by means of AGA and AEA testing A disease more frequent than expectedGluten is just the trigger, endomysium the target AEA and other autoantibodies in CD are gluten-dependen HLA DQ2 restricted anti-gluten T cells in biopsies The “celiac iceberg” model
The Age of transglutaminase: from target to diagnostic tool.1997-Widening spectrum of CD associated disorderstTG antibodies One biopsy Screening on a few blood drops Anti-deaminated gluten peptides (DGP) antibodies ESPGHAN guidelines for diagnosis without biopsyTissue transglutaminase (tTG) is the autoantigen in endomysium tTG increase the affinity of gluten peptides for HLA DQ2 Interaction between tTG and gluten peptides could be responsible for autoimmune reactions and “antigen spreading”
The future. Will new tools identify new diseases?2011-A new definition for gluten intolerance with normal serum tTG antibodiesMucosal tTG in potential CDMucosal assay for local tTG antibodies Phage display libraries to unravel CD pathology
Table 2 Old and new celiac disease before and after the identification of age of anti-endomysium anti-bodies
Old CD, Pre-AEA ageNew CD, Post-AEA age
PathogenesisImmune, intestinalAutoimmune, systemic
DiagnosisAGA + 3 biopsiesAEA + 1 biopsy
PrevalenceRare 1:500-1:5000Frequent 1:100 worldwide
Clinical pictureMalabsorption syndromeAutoimmune disorders Malabsorption syndrome
Intestinal pathologySevere villous atrophy and criptae hypertrophySevere villous atrophy and criptae hypertrophy or increased mucosal lymphocytes (latent celiac disease)