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Coeliac disease (British English) or celiac disease (American English) is a long-term autoimmune disorder, primarily affecting the small intestine, where individuals develop intolerance to gluten, present in foods such as wheat, rye and barley. [10]
For people with celiac disease, a lifelong strict gluten-free diet is the only effective treatment to date; [23] [69] For people diagnosed with non-celiac gluten sensitivity, there are still open questions concerning for example the duration of such a diet.
In these people, the gluten-free diet is demonstrated as an effective treatment, [7] [8] [9] but several studies show that about 79% of the people with coeliac disease have an incomplete recovery of the small bowel, despite a strict gluten-free diet. [10] This is mainly caused by inadvertent ingestion of gluten. [10]
This condition is known as refractory coeliac disease (RCD), defined as malabsorption due to gluten-related enteropathy (villous atrophy or elevated intraepitheal lymphocytes) after initial or subsequent failure of a strict gluten-free diet (usually 1 year) and after exclusion of any disorder mimicking coeliac disease.
In 1924, Sidney V. Haas (1870–1964) described the first SCD for the treatment of children with celiac disease; this was known as the banana diet. [2] [3] Haas described a trial with 10 children; all 8 children treated with bananas went into remission, and the two control children died. [4]
As antibody-negative coeliac disease is recognised, HLA status, persistence or progression of the duodenal IEL numbers following a gluten challenge, followed by symptomatic improvement on a gluten-free diet, has been used to be more certain about the diagnosis, which was made in 22% of one series of over 200 adult cases. [5]
Celiac disease affects ~1% of the population in most parts of the world. [3] Ninety to one hundred percent of patients with coeliac disease have inherited genes at the HLA-DQ locus that encode HLA-DQ2 and/or HLA-DQ8 serotype proteins. [12] About 2–3% of individuals who inherit these HLA-DQ2 and/or HLA-DQ8 serotypes develop coeliac disease. [10]
Today, with serological testing (determination of coeliac disease-specific antibodies in the blood) and duodenal biopsy with histological testing being available for diagnosing coeliac disease, patients with suspected coeliac disease are strongly advised to undergo both serological and biopsy testing before undertaking a gluten-free diet. [7]