WGO Global Guidelines - Celiac Disease - CAROLINA CIACCI, MD - PETER GREEN, MD - JULIO C. BAI, MD

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54 WORLD GASTROENTEROLOGY NEWS JULY 2016 Editorial | Expert Point of View | Gastro 2016: EGHS-WGO | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events Celiac Disease CAROLINA CIACCI, MD University of Salerno Salerno, Italy PETER GREEN, MD Columbia University New York, New York, USA JULIO C. BAI, MD Del Salvador University Buenos Aires, Argentina DEFINITIONS Celiac disease (CD) is a chronic enteropathy produced in genetically predisposed subjects by the ingestion of gluten. Gluten represents the protein mass that remains when wheat dough is washed to remove starch. Gliadins and glutenins are the major protein components of gluten and are present in wheat, rye, and barley. Non-celiac gluten sensitivity is a condition in which people in whom CD and wheat allergy has been excluded present symptoms which im-prove with a gluten free diet (GFD). Wheat allergy is an adverse im-munologic reaction to wheat proteins, mostly IgE- but rarely also non-IgE mediated. It may present as an allergy affecting the skin, gastrointestinal or respiratory tract, a contact urticarial, but also as the so called exercise-induced anaphylaxis, or as asthma/ rhinitis (baker’s asthma). EPIDEMIOLOGY CD is common, with a world preva-lence of about 1%, varying from 0.14%-5.7%. The observed increased number of new cases in the last decades is due to better diagnostic tools and thorough screening of individuals con-sidered to be at high-risk for the disor-der. However, the ratio of diagnosed to undiagnosed cases of CD varies from country to country, suggesting that most cases of CD are still undetected. Globally, there is the need to increase the knowledge of disease, especially among primary care doctors. ROLE OF GENETICS The MHC-HLA locus is the most important genetic factor in the development of CD. The disorder is associated with human leukocyte antigen (HLA)-DQA1 and HLA-DQB1 genes, and the alleles HLA DQ2 (95%) and DQ8 (the rest) are present in the vast majority of CD patients. Recent data showed that also HLA class-I molecules are associated to the disorder. In honor of World Digestive Health Day 2016: “Diet and the Gut,” the World Gastroenterology Organisation will soon be publishing an update to the Celiac Disease Guideline and Cascade. Watch your inbox for this update! In preview of the coming guideline update, Drs. Bai, Ciacci, and Green provide an overview of Celiac Disease. This article and many more topics focused on Your Gut and Diet Health can be found in the WGO Handbook on Diet and the Gut by visiting www.worldgastroenterology.org/wgo-foundation/wdhd/wdhd-2016/tools--resources.

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