In Figure 1, takes place in five main steps: (1) the glu- addition to medical care for patients with CD, the role tamine residues of the ingested gliadin are con- of the nutritionist is essential in initiating and adher- verted into glutamates by tissue transglutaminase. of asymptomatic, oligosymptomatic, or extra-intesti- nal often misleading forms hence, the diagnostic Immunopathologic aspects delay and the risk of potentially serious complica- 7–10 8,11 The pathogenic process of CD, as described in tions can be avoided by implementing GFD. Indeed, sero-epidemiological studies suggest that In spite of the classical symptoms strongly sugges- for each diagnosed CD case, there could be 3–7 tive of CD, the last decades have seen the emergence undiagnosed cases. 5,6 it can be resolved by a gluten-free diet (GFD).
2 International Journal of Immunopathology and Pharmacology 10,13,29 presence of intestinal or extra-intestinal symptoms, of the disease through serological testing.
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Email: Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License () which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (). However, Cadi Ayyad University, Marrakech, Morocco the amino acid sequences inducing CD-associated Corresponding author: immune reactions are less prevalent in avenins, Brahim Admou, Center of Clinical Research, University Hospital which explains the tolerance of small amounts of Mohamed-VI, Avenue Ibn Sina, Marrakech 40080, Morocco.
Gluten refers to insoluble cereal proteins, includ- Laboratory of Immunology, Center of Clinical Research, University Hospital Mohammed VI, Marrakech, Morocco ing prolamins found in wheat (gliadins), rye (seca- Bioscience Research Laboratory, Faculty of Medicine and Pharmacy, lins), barley (hordein), and oats (avenins). Keywords Celiac disease, diagnosis, gluten-free diet, gluten-free drugs Date received: 24 February 2021 accepted: 18 March 2021 Unlike CD, recently described gluten sensitivity Introduction is characterized by negative serological tests and Celiac disease (CD) is an immune-mediated sys- the absence of villous atrophy, and despite the temic disorder triggered by gluten consumption, 1–3 occurring in genetically predisposed individuals. This underlines the importance of the contribution of the pharmacist in the care of patients with CD within the framework of close collaboration with physicians and nutritionists. The presence of the gluten in several forms of medicine requires the sensitization of physicians when prescribing, and particularly when dispensing gluten-containing formulations by pharmacists. This explains the key role of the dietitian and the active participation of patients and their families throughout the disease- management process. The main challenge in managing CD is the implementation and compliance with a gluten-free diet (GFD). In children with classical signs or even when asymptomatic, with high levels of CD-linked markers and positive HLA DQ2 and/or DQ8 molecules, the current trend is to confirm the diagnosis on basis of the non-systematic use of the biopsy, which remains obligatory in adults.
Owing to multiple differential diagnoses, celiac disease cannot be confirmed based on serological positivity alone, nor on isolated villous atrophy. Positive TG2 serology should be corroborated by anti-endomysium antibody testing before considering an intestinal biopsy. The diagnosis consists of serological testing based on IgA anti-transglutaminase (TG2) antibodies combined with IgA quantification to rule out IgA deficiency, a potential misleading factor of CD diagnosis. Immunology and pathology laboratories have a fundamental role in diagnosing and monitoring CD. CD is a multidisciplinary health concern involving general medicine, pediatric, and adult gastroenterology, among other disciplines. Celiac disease: Understandings in diagnostic, nutritional, and medicinal aspects Celiac disease: Understandings in diagnostic, nutritional, and medicinal aspectsĬeliac disease (CD) is characterized by clinical polymorphism, with classic, asymptomatic or oligosymptomatic, and extra- intestinal forms, which may lead to diagnostic delay and exposure to serious complications.
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