Celiac disease occurs as a result of a T-cell-dependent immune reaction on gluten peptides. It is a complex genetic disorder that is mediated by an unknown number of genes, of which more than 50 have been identified in whole genome association studies. The genetic component helps identify oligosymptomatic or even subclinical celiacs by screening first-degree relatives and patients suffering from other autoimmune diseases. To offer sensitive as well as specific diagnostics for celiac disease (serology and small intestinal histology) some general rules should be followed including performing diagnostics only when patients are on a gluten-containing diet or after an appropriate re-exposition. Established treatment is currently restricted to a gluten-free diet. However, future treatment options might include endopeptidase-mediated inactivation of gluten peptides, stabilization of the epithelial barrier, tissue-transglutaminase inhibition or vaccination.
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