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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.
