Abstract
Celiac disease (CD) is a systemic immune-mediated disorder caused by the ingestion of gluten-containing grains in genetically susceptible persons. It is one of the most common lifelong disorders, affecting approximately 1% of the general population. The prevalence of CD has increased in developed countries over recent decades, pointing to the role of additional environmental triggers other than gluten. It has been hypothesized that intestinal infections, the amount and quality of gluten, the intestinal microbiota, and early nutrition are all possible triggers of the switch from tolerance to an immune response to gluten. Two recent randomized controlled trials have been performed to clarify the relationship between the age at which gluten is introduced to a child’s diet and the risk of CD, showing that timing of gluten introduction does not modify the risk of CD. Both trials also showed that breastfeeding compared with no breastfeeding or breastfeeding duration or breastfeeding during gluten introduction have no effect on the risk of CD. The two trials, although not designed to address this issue, have shown that intestinal infections seem not to influence the risk of CD. Further studies are still needed to explore the missing environmental factors of CD for future prevention.
Highlights
Celiac disease is a systemic immune-mediated disorder caused by the ingestion of gluten-containing grains in genetically susceptible persons
As stated in the editorial published on this issue, “we are still in search of environmental factors that may affect the development of the disease” and “the two trials—CELIPREV and PREVENT-Celiac disease (CD)—are today a starting point rather than an end point of the research in this field” [48]
A revision of the current recommendations of the European Society of Gastroenterology, Hepatology and Pediatric Nutrition (ESPGHAN) on weaning [49], which recommend the introduction of gluten from four to seven months of age, during the “window of tolerance”, and the introduction of gluten while the infant is still being breastfed in order to reduce the risk of celiac disease is strongly advised
Summary
Celiac disease is a systemic immune-mediated disorder caused by the ingestion of gluten-containing grains (wheat, rye, and barley) in genetically susceptible persons. It is one of the most common lifelong disorders on a worldwide basis, affecting approximately 1% of the general population [1,2]. The frequency of celiac disease has increased in developed countries over the last decades, a finding that points out the causal role of possible environmental triggers additional to gluten [3]
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