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Celiac disease

Published on January 5, 2011 Reviewed on April 12, 2022   48 min

A selection of talks on Clinical Practice

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0:00
Hello, my name is Ciaran Kelly and I'm the medical director of the Celiac center at Beth Israel Deaconess Medical Center, which is an affiliate of Harvard Medical School in Boston Massachusetts,
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and I'll be speaking on celiac disease.
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The first descriptions of celiac disease in the medical literature have been attributed to Aretaeus who worked in Cappadocia and in 50AD wrote a narrative describing the clinical manifestations of celiac disease. In 1888, Samuel Gee, who worked in London, wrote his treaties on the celiac affection and described many of the classical and atypical features of celiac disease, including descriptions of the disease presenting in children and in adults. He also made the very astute observation that if the disease is to be cured at all, it must be by means of diet. However, his dietary recommendations were somewhat off key in that he recommended bread toasted on both sides as a treatment for celiac disease and as we know, toasting bread does not inactivate the toxic gluten moieties of wheat. In 1950, a major breakthrough was made when a Dutch pediatrician identified wheat gluten as a toxic factor for children with celiac disease. Based on at the clinical observation that his patients with celiac disease improved during rationing that occur during the Second World War when, of course, wheat was less available whereas the rest of his population the rest of his practice, was becoming less well nourished, those with celiac disease thrived. Based on this observation, he hypothesized that celiac disease was caused by something that was less available during Second World War rationing. And this led him ultimately to the identification of wheat, barley, and rye as the toxic factors in celiac disease. In 1997 doctor Schuppan and his colleagues working in Germany identified tissue transglutaminase as an autoantigen in celiac disease and this has led to a number of major advances in celiac disease. The most evident being in the way in which we diagnose celiac disease using tissue transglutaminase antibody testing. However, tissue transglutaminase also has a role in disease pathogenesis, which I'll touch upon later. And has also changed our understanding of the epidemiology of celiac disease, which I'll also discuss later.