undefined

undefined

doi:undefined

https://doi.org/10.1159/000551888

Gene-Environment Interactions in Celiac Disease: The Role of the Intestinal Epithelium

Apr 14, 2026
Lifestyle Genomics
Sara Rahmani +3 more

Listen

Abstract

Translate Article

Plain Language SummaryCeliac disease (CeD) is a lifelong condition in which the body’s immune system reacts abnormally to gluten, a group of proteins found in wheat, barley, and rye. CeD only develops in people with certain genes, but not everyone who has these genes gets the disease. This suggests that other factors, such as diet (e.g., high load of gluten), infections, or bacteria living in the gut, may also play a role. What makes CeD unique among other chronic inflammatory conditions is that we have identified the main environmental driver (gluten) and its strong link with specific genetic markers. When someone with CeD eats gluten, their immune system mistakenly attacks the lining of their small intestine, damaging (flattening) the tiny finger-like projections (villi) that absorb nutrients. Consequently, people with CeD may experience bowel symptoms, nutrient deficiencies, fatigue, or even complications outside the gut, such as anemia or bone loss. CeD is diagnosed using a blood test that detects specific antibodies and by confirming intestinal damage in biopsy (small piece of tissue taken during an endoscopy) of the small intestine. Currently, the only effective treatment is a strict, gluten-free diet (GFD) for life that helps most people, but it is not always effective. No medication or cure is available. This review explores how genes, lifestyle (diet, infections, and gut bacteria), and gut lining interact in the development of CeD. It highlights new research showing that the cells lining the intestine are not just passive target of the disease but may also play an active role in disease. A better understanding of these complex interactions could help develop new therapeutic strategies beyond the GFD.

Similar Papers

Research Article
112
10.1016/j.jand.2012.06.009

Gluten-Free Diet: Imprudent Dietary Advice for the General Population?

Aug 28, 2012
Journal of the Academy of Nutrition and Dietetics
Glenn A Gaesser + 1 more

Gluten-Free Diet: Imprudent Dietary Advice for the General Population?

Front Matter
7
10.1053/j.gastro.2014.04.027

Management of Celiac Disease: Beyond the Gluten-Free Diet

Apr 29, 2014
Gastroenterology
Sheila E Crowe

Management of Celiac Disease: Beyond the Gluten-Free Diet

Research Article
8
10.1542/pir.2020-000711

Celiac Disease.

Oct 1, 2021
Pediatrics in review
Tracy R Ediger + 1 more

Celiac Disease.

Research Article
381
10.1053/j.gastro.2005.02.027

Association of celiac disease and intestinal lymphomas and other cancers

Apr 1, 2005
Gastroenterology
Carlo Catassi + 2 more

Association of celiac disease and intestinal lymphomas and other cancers

Front Matter
12
10.1016/j.gie.2011.07.021

The role of capsule endoscopy in patients with nonresponsive celiac disease

Dec 1, 2011
Gastrointestinal Endoscopy
Christina A Tennyson + 1 more

The role of capsule endoscopy in patients with nonresponsive celiac disease

Research Article
10.1097/mpg.0b013e3182445059

XVIII Latin American Congress

May 1, 2012
Journal of Pediatric Gastroenterology and Nutrition
C.A Velasco‐Benítez + 5 more

XVIII Latin American Congress

Front Matter
23
10.1016/j.cgh.2008.03.017

Celiac Disease Beyond the Gut

Jun 10, 2008
Clinical Gastroenterology and Hepatology
Alberto Rubio-Tapia + 1 more

Celiac Disease Beyond the Gut

Research Article
206
10.1053/j.gastro.2005.02.025

Follow-up of patients with celiac disease: Achieving compliance with treatment

Apr 1, 2005
Gastroenterology
Michelle Maria Pietzak

Follow-up of patients with celiac disease: Achieving compliance with treatment

Research Article
22
10.4103/0256-4947.75779

Celiac disease in children and adolescents at a singe center in Saudi Arabia

Jan 1, 2011
Annals of Saudi Medicine
Omar I Saadah

BACKGROUND AND OBJECTIVES:Celiac disease (CD) is an immune-mediated enteropathy, induced by gluten in genetically susceptible individuals. The objective of this study was to describe the clinical pattern of CD in children from the western region of Saudi Arabia.DESIGN AND SETTING:Retrospective, hospital-based.PATIENTS AND METHODS:This study included children with a biopsy-proven diagnosis of CD made between September 2002 and July 2007. Children were admitted to the endoscopy unit for a small-bowel biopsy if they had gastrointestinal symptoms suggestive of CD or if they were positive for a CD-antibody screen performed for the high-risk groups.RESULTS:Eighty children were identified with a diagnosis of CD. Their mean (SD) age was 9.6 (4.9) years (range, 0.5-18 years). There were 44 (55%) female patients. Forty-one (51%) patients were detected during screening of high-risk groups, while 39 (49%) patients had classical symptoms of malabsorption. The screening also detected asymptomatic patients. Of 65 patients tested, 11 (17%) had elevated liver function tests, which reverted to normal after introduction of a gluten-free diet (GFD) except in one case. Seventy-three (91%) patients were positive for anti-tissue transglutaminase antibodies, 18 (23%), for IgG anti-gliadin antibodies; and 46 (58%), for IgA anti-gliadin antibodies. Forty-one (56%) patients showed good adherence to GFD as assessed by dietary history and the decline in anti-tTG level.CONCLUSION:CD may present with classical symptoms or be identified through screening programs. Growth and laboratory abnormalities usually improve after introduction of a GFD. Adherence to a GFD remains a problem; therefore, thorough assessment and counseling at the time of diagnosis and ongoing care are crucial.