Celiac Disease—New Insights in Pathogenesis, Diagnosis and Management

Celiac disease is defined as a systemic immunological disorder caused by gluten in genetically predisposed individuals, who have a variety of gluten-dependent symptoms, specific antibodies, HLA DQ2 and DQ8 histocompatibility antigen presence and enteropathy. Celiac disease is considered one of the most common autoimmune diseases. Its prevalence, depending on the studied population and methodology, is estimated at 0.75-1.6% of the general population.Celiac disease is an autoimmune disease that develops as a result of the interaction of genetic, immunological, and environmental factors. During the complex immune reaction, most of the cells involved in inflammatory processes are activated, which leads to the gradual atrophy of intestinal villi and the proliferation of enterocytes within the intestinal crypts. The pathogenesis of celiac disease is extremely complicated and is still being studied.According to the current guidelines, in order to correctly diagnose celiac disease, the following criteria should be taken into account: clinical symptoms (intestinal and extraintestinal), presence of antibodies against tissue transglutaminase in the IgA class, taking into account the level of total IgA and presence of typical histological changes in a duodenal bioptates.The important clinical challenge is the diet-resistant celiac disease, causing the severe complications,Currently, the basic method of treating celiac disease is an elimination diet (i.e. exclusion of products that may contain gluten from the diet), however, new therapeutic strategies are still being sought, mainly based on supplementation of exogenous endopeptidases, modification of the immune response, the use of zonulin inhibitors and transglutaminase 2 inhibitors. Clinical trials of new drugs are ongoing. The gradually expanding knowledge of the pathogenesis of celiac disease may allow the development of new therapeutic strategies both for patients with a mild course of the disease as well as those diet-resistant.