An update on the multiple faces of celiac disease

Published on October 1, 2007 Updated on May 1, 2018   46 min

Other Talks in the Series: Autoimmunity

Other Talks in the Series: Periodic Reports: Advances in Clinical Interventions and Research Platforms

My name is Professor Aaron Lerner. I am a pediatrician, specializes in Pediatric Gastroenterology and Nutrition, and the Adult Gastroenterology. Originally, I am from Israel, from the Technion - Israel Institute of Technology. But now, I am doing my research in the Aesku.Kipp Institute in Germany. We are going to talk about some updates on the multiple faces of Celiac disease.
In fact, we are talking about a lot of products that contains gluten and gluten is the main environmental inducer of Celiac disease. But before starting, let's have a definition. What is Celiac disease?
Celiac disease is an autoimmune disorder elicited on genetically predisposed individuals that are consuming gluten-containing grains. The gluten is the offending agent but there are some other prolamins that the patients are not allowed to ingest. I'm talking about wheat, barley, rye, and oats. Epidemiologically speaking, the incidence is one to two percent in the population. However, there are some Nordic countries like Sweden, Norway, Ireland, most of the Germany, Finland, etc, where the incidence is above two percent. In the last couple of years, there were some observations that in the Sahara desert, some tribes, they have an increased incidence of Celiac disease amounting to six to seven percent. This is most probably because of genetic inbreeding. Their disease has some geographical ingredient. It is much more in the Northern, in the Western countries. We are talking about life-long and gluten-dependent autoimmune condition. Being auto-immune, there is always some genetic aspect to it. But always, there are environmental factors and more and more, we are discovering much more environmental factors. Up 'til now, gluten is the causative. However, many others associated environmental factors were suggested like infection, be it viral or bacterial; the age of the infant; the infant nutrition; the amount and the type of gluten ingested during the first year of life; early antibiotics in the first year of life; microbiota or dysbiota ratio is most probably contributing to a lot of the disease; and lately, the couple of publication about industrial processed food additives that they may affect Celiac disease. Of course nowadays, some modern lifestyle can affect the disease like the amount of stress, etc. Clinically speaking, there is epidemiological shift in the disease phenotype. The disease is much more prevalent in the last three or four decades in advanced age, and the clinical presentation is much more subtle. We see more and more latent hypo-symptomatic or asymptomatic presentation. We know also the evolutionary aspect of wheat might be important because during evolution, I'm talking about the last 10,000 years, the gluten content toxicity and immunogenicity is increasing in the wheat.

An update on the multiple faces of celiac disease

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