2001 Odyssey in celiac disease

Celiac disease, a long-life intolerance of the intestinal mucosa to gluten in genetic susceptible individuals, is characterized by gluten-dependent changes in villous morphology and/or signs of immunological activation in the lamina propria. Celiac disease, a heritable condition, seems to be related both with HLA and non-HLA genes. Gluten is the most important factor in precipitating celiac disease, it has been found in wheat but also in other cereals such as barley, rye and oats, although the role of the latter in celiac disease is still controversial. Serological screening of celiac disease is nowadays based on antiendomysial antibodies and anti-tissue transglutaminase antibodies. Recently, anti endomysial antibodies of IgG1 isotype have been reported as a new tool in the screening for celiac disease. Diagnosis is still based on the histological finding of intestinal mucosa atrophy with crypt hyperplasia on a gluten-containing diet with return to normal after a gluten-free diet, but it has recently been shown that celiac disease can also occur in the absence of mucosal damage. Intestinal mucosa biopsy culture in the presence of gliadin is able to reproduce all the immunological features of celiac disease, therefore the organ culture with in vitro gliadin challenge could be an effective useful tool in the diagnostic work-up of celiac disease.