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Healthcare professional Resource for Gluten Related Disorders.

Dr. Schär Institute

Nutritional therapy for celiac disease

A strict gluten-free diet is currently the only treatment for celiac disease.
The only treatment for celiac disease is lifelong avoidance of all foods containing gluten. Even trace amounts of gluten can cause damage to the mucosa of the small intestinal [1]. Gluten is found in wheat, rye, barley and contaminated oats, and products that contain these ingredients. In addition to obvious sources of gluten, such as breads, pasta, cookies and baked goods, smaller quantities are also present in less obvious food products including processed meats, soups, sauces, candies and seasonings. Careful label reading is therefore recommended when shopping.

Gluten-free products

A large number of gluten free products are available in supermarkets, health food stores and online. Through the Evidence Analysis Library of the Academy of Nutrition and Dietetics dietary guidelines have been developed to provide a dietary pattern to meet the specific needs of the celiac patient [2]. It is important to encourage your patients to select a wide variety of naturally gluten-free foods as well as those manufactured products that contain gluten-free whole or ancient grains to meet the nutritional needs of individuals with celiac disease.

Benefits of a gluten-free diet

  • Normalization of antibody values
  • Regeneration of small intestinal mucosa
  • Reduced risk of  medical complications/long term consequences
  • Improved nutrient absorption
  • Improvement in general health and wellbeing
  • Improvement in quality of life

Conditions associated with undiagnosed/untreated celiac disease

Failure to accurately diagnose celiac disease or to follow a strict gluten free dietary pattern following diagnosis may result in a number of serious long term health consequences:


Iron-deficiency anemia

Anemia and other micronutrient deficiencies are common in newly diagnosed celiac disease due to malabsorption caused by small bowel villous atrophy. Adherence to a strict gluten free diet will allow the small intestine to heal.


Undiagnosed/ untreated celiac disease is associated with low bone mineral density, osteoporosis and increased risk of fractures. Approximately 75% of adults with untreated celiac disease suffer from osteopenia or osteoporosis. A DEXA scan is recommended as part of the diagnostic process to assess bone health [2]. A strict gluten free diet has been shown to improve bone mineral density [1].


Compared to the general population celiac disease is associated with a modestly increased risk of small bowel lymphoma, namely non-Hodgkin’s lymphoma [3]. However, overall risk remains low and is likely to be reduced to the same level as the general population following 3-5 years on a gluten free diet [3,4].
  1. Fasano, A., Catassi, C. (2012). Clinical practice. Celiac disease. N Engl J Med.; 20; 367(25):2419-26. doi: 10.1056/NEJMcp1113994.
  2. Academy of Nutrition and Dietetics
  3. Corazza GR, Di Stefano M, Maurino E. Bones in coeliac disease: diagnosis and treatment. Gastroenterology 2005 19(3): 453-465
  4. West J, Logan RFA, Smith CJ et al. Malignancy and mortality in people with coeliac disease: population based cohort study. BMJ 2004 329:716-718
  5. Holmes GKT, Prior P, Lane MR et al. Malignancy in coeliac disease, effect of a gluten free diet. Gut 1989. 30: 333-338.
  6. Askling J, Linet M, Gridley G. Cancer incidence in a population-based cohort of individuals hospitalised with coeliac disease or dermatitis herpetiformis . Gastroenterology 2002. 123(5):142-135

Further information on this topic

Professional articles 3

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Presentations 1

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Studies 3

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Gut Microbiota in Health and Disease

Ms Wilson’s article reviews the influence of the environment on the gut microbiome and discusses potential dietary avenues to improve it.

>> Read more... <<<
Wilson, B;

The influence of the microbiome on gluten-related diseases

The increasing prevalence of food intolerances, especially in relation to certain carbohydrates, represents a global health problem. Moreover, intolerance of gluten and gluten-bound substances, e.g. amylase-trypsin inhibitor (ATI) is blamed for intestinal (e.g. meteorism, pain, constipation, diarrhea) and extra intestinal symptoms (e.g. fatigue, headaches, joint pain, skin irritation) in affected patients. The pathogenesis of food intolerances is blamed on factors such as changes in the composition of the intestinal flora and its influence on mucous membrane immune tolerance.

>> Read more... <<<
Zopf, Y; Dieterich, W;

The importance of the microbiota in the pathogenesis and treatment of celiac disease

The composition of the gut microbiome is influenced by many factors. The microbiota may also be a key influencer in overall health and disease outcomes.

>> Read more... <<<
Körner, U; Groeneveld, M;

Gluten and functional gastrointestinal disorders: is it worth the challenge? (2015)

Luca Elli MD, PhD
Center for the Prevention and Diagnosis of Celiac Disease
Fondazione IRCCS Ca’ Granda
Ospedale Maggiore Policlinico, Milano, Italy

16th International Coeliac Disease Symposium 2015 in Prague
Pre-Conference Workshop on Gluten Sensitivity "The Evolving Planet of Gluten Related Disorders"

Potential Celiac Children: 9-Year Follow-Up on a Gluten-Containing Diet


Potential celiac disease (CD) is defined by the presence of serum anti-tissue-transglutaminase (anti-TG2) antibodies and normal duodenal mucosa. The major clinical problem is the management of asymptomatic patients and how to predict the development of villous atrophy. This prospective longitudinal cohort study describes the natural history of potential CD up to 9 years and explores risk factors associated with the development of mucosal damage.

Two hundred and ten potential CD children were eligible for the study; 175/210 asymptomatic children were left on a gluten-containing diet. Antibodies and clinical symptoms were checked every 6 months, and a small bowel biopsy was taken every 2 years to evaluate histological, immunohistochemical, and anti-TG2 deposits. Patients were genotyped for HLA and a set of non-HLA CD-associated genes.

Forty-three percent of patients showed persistently elevated anti-TG2 level, 20% became negative during follow-up, and 37% showed a fluctuant anti-TG2 course with transiently negative values. At 3 years of follow-up, 86% of cases remained potential; 73 and 67% still had normal duodenal architecture at 6 and 9 years, respectively. Male sex, slight mucosal inflammation at time 0, and a peculiar genetic profile delineate a cohort of individuals who were prone to develop mucosal damage during time.

A sizeable proportion of asymptomatic potential celiac patients showed fluctuation or negativization of antibody production, and many of these, with persistently positive anti-TG2, did not develop mucosal damage after 9 years of follow-up. Celiac population is a multivariate aggregate of individuals with different genetic and phenotypic profiles. Caution is required before prescribing a gluten-free diet for life to asymptomatic individuals with potential CD.

Resource: The American Journal of Gastroenterology 109, 913-921 (June 2014)

Renata Auricchio, Antonella Tosco, Emanuela Piccolo, Martina Galatola, Valentina Izzo, Mariantonia Maglio, Francesco Paparo, Riccardo Troncone and Luigi Greco
2014 June

Follow-up of pediatric celiac disease: value of antibodies in predicting mucosal healing, a prospective cohort study


Background: In diagnosing celiac disease (CD), serological tests are highly valuable. However, their role in following up children with CD after prescription of a gluten-free diet is unclear. This study aimed to compare the performance of antibody tests in predicting small-intestinal mucosal status in diagnosis vs. follow-up of pediatric CD.

Methods: We conducted a prospective cohort study at a tertiary-care center. 148 children underwent esophohagogastroduodenoscopy with biopsies either for symptoms ± positive CD antibodies (group A; n = 95) or following up CD diagnosed ≥ 1 year before study enrollment (group B; n = 53). Using biopsy (Marsh ≥ 2) as the criterion standard, areas under ROC curves (AUCs) and likelihood-ratios were calculated to estimate the performance of antibody tests against tissue transglutaminase (TG2), deamidated gliadin peptide (DGP) and endomysium (EMA).

Results: AUCs were higher when tests were used for CD diagnosis vs. follow-up: 1 vs. 0.86 (P = 0.100) for TG2-IgA, 0.85 vs. 0.74 (P = 0.421) for TG2-IgG, 0.97 vs. 0.61 (P = 0.004) for DPG-IgA, and 0.99 vs. 0.88 (P = 0.053) for DPG-IgG, respectively. Empirical power was 85% for the DPG-IgA comparison, and on average 33% (range 13–43) for the non-significant comparisons. Among group B children, 88.7% showed mucosal healing (median 2.2 years after primary diagnosis). Only the negative likelihood-ratio of EMA was low enough (0.097) to effectively rule out persistent mucosal injury. However, out of 12 EMA-positive children with mucosal healing, 9 subsequently turned EMA-negative.

Conclusions: Among the CD antibodies examined, negative EMA most reliably predict mucosal healing. In general, however, antibody tests, especially DPG-IgA, are of limited value in predicting the mucosal status in the early years post-diagnosis but may be sufficient after a longer period of time.

Resource: BMC Gastroenterology 2014, 14:28
Vécsei, E; Steinwendner, St; Kogler, H; et al.;
2014 February

Celiac disease: diagnosis and management.


Celiac disease is an autoimmune disorder of the gastrointestinal tract. It is triggered by exposure to dietary gluten in genetically susceptible individuals. Gluten is a storage protein in wheat, rye, and barley, which are staples in many American diets. Celiac disease is characterized by chronic inflammation of the small intestinal mucosa, which leads to atrophy of the small intestinal villi and subsequent malabsorption. The condition may develop at any age. Intestinal manifestations include diarrhea and weight loss. Common extraintestinal manifestations include iron deficiency anemia, decreased bone mineral density, and neuropathy. Most cases of celiac disease are diagnosed in persons with extraintestinal manifestations. The presence of dermatitis herpetiformis is pathognomonic for celiac disease. Diagnosis is supported by a positive tissue transglutaminase serologic test but, in general, should be confirmed by a small bowel biopsy showing the characteristic histology associated with celiac disease. The presence of human leukocyte antigen alleles DQ2, DQ8, or both is essential for the development of celiac disease, and can be a useful genetic test in select instances. Treatment of celiac disease is a gluten-free diet. Dietary education should focus on identifying hidden sources of gluten, planning balanced meals, reading labels, food shopping, dining out, and dining during travel. About 5% of patients with celiac disease are refractory to a gluten-free diet. These patients should be referred to a gastroenterologist for reconsideration of the diagnosis or for aggressive treatment of refractory celiac disease, which may involve corticosteroids and immunomodulators.

Resource: Am Fam Physician. 2014 Jan 15;89(2):99-105.
Pelkowski, T; Viera, A;
2014 January