Coeliac disease from pathogenesis to clinical practice: current concepts

Coeliac disease is an autoimmune disease affecting the small intestine in genetically predisposed subjects following the ingestion of gluten. Many advances have been made towards understanding the pathogenic mechanisms that underlie the development of coeliac disease. The interaction between genetic, environmental and immunological factors is the main pathophysiological aspect, but over the last few years growing importance has been given to the role of the intestinal barrier and in particular to the alteration of intestinal microbiota. Clinical manifestations mainly include signs and symptoms typical of malabsorption, but atypical or subtle clinical manifestations are not rare. The diagnosis must always be made in accordance with current guidelines, based on the finding of serological markers and typical intestinal mucosal alterations detected by upper endoscopic procedure and confirmed with histological examination. Clinical management is based on the strict elimination of gluten from the diet, and a regular monitoring of the nutritional status and the possible occurrence of complications and or associated clinical conditions. In this review we have been described the current evidences on pathogenesis and clinical practice of coeliac disease.