Celiac disease and gut microbiota: Q&A


Celiac disease and gut microbiota: Q&A

What is celiac disease?

A: Celiac disease is an autoimmune disorder where the ingestion of gluten leads to damage in the small intestine of genetically predisposed individuals. It mainly affects people in Europe and North America, with a prevalence of 0.5-1%, but higher rates are seen in the Middle East and Asia-Pacific.

How is celiac disease diagnosed?

A: The diagnosis of celiac disease has advanced to include serological tests such as anti-tissue transglutaminase 2 and anti-endomysium antibodies, alongside the gold-standard small bowel biopsy, which assesses the degree of intraepithelial lymphocytes, crypt hyperplasia, and villous atrophy.

What is the main treatment for celiac disease?

A: The primary treatment for celiac disease involves a lifelong avoidance of gluten, a protein found in wheat, barley, and rye. This diet helps manage symptoms and prevent further intestinal damage.

How does gut microbiota relate to celiac disease?

A: The gut microbiota plays a crucial role in the development and manifestation of celiac disease, a relationship that’s complex and multifaceted. Here’s how they relate:

  1. Genetic Susceptibility and Microbiota Composition: Individuals genetically predisposed to celiac disease (carriers of HLA-DQ2 and HLA-DQ8 alleles) exhibit differences in gut microbiota composition compared to those without such genetic markers. This suggests that genetic factors influencing celiac disease also affect the diversity and balance of gut microbes.
  2. Immune System Modulation: The gut microbiota has a significant impact on the immune system’s development and function. In celiac disease, dysbiosis or an imbalance in the gut microbiota may contribute to an inappropriate immune response to dietary gluten. This is partly due to the microbiota’s role in regulating the balance between proinflammatory and anti-inflammatory mediators and metabolites, which can exacerbate or mitigate immune reactions.
  3. Intestinal Permeability: The integrity of the intestinal barrier is crucial for preventing substances from leaking out of the gut into the bloodstream, which can trigger immune responses. Certain gut microbes produce substances that affect the permeability of the intestinal lining. In celiac disease, this can lead to an increased passage of gluten fragments into the gut mucosa, prompting an immune response.
  4. Inflammation and Dysbiosis: Individuals with celiac disease often exhibit changes in the composition of their gut microbiota, with an increase in pathogenic bacteria and a decrease in beneficial bacteria. This dysbiosis can contribute to chronic intestinal inflammation, characteristic of celiac disease, by promoting the production of inflammatory cytokines and altering mucosal immunity.
  5. Influence on Treatment: A gluten-free diet, the mainstay treatment for celiac disease, also impacts the composition of the gut microbiota. Changes in diet can lead to alterations in the microbial community, affecting the abundance of bacteria that play roles in inflammation, immune regulation, and even the digestion of certain foods. Understanding how a gluten-free diet modifies gut microbiota is essential for optimizing celiac disease management and could lead to adjunct treatments, such as probiotics, to support gut health and potentially alleviate symptoms.

Can genetic predisposition influence gut microbiota composition in celiac disease?

A: Yes, genetic predisposition, especially related to HLA-DQ2 and HLA-DQ8 alleles, significantly influences the composition of the gut microbiota. Studies have shown differences in the microbial composition of infants based on their genetic risk of developing celiac disease, suggesting early microbial composition can affect immune development and disease predisposition.

Do environmental factors affect the risk of developing celiac disease?

A: Environmental factors such as the type of birth, breastfeeding, antibiotic use, and early-life infections can impact the composition of the gut microbiota and potentially influence the risk of developing celiac disease. These factors may affect the immune system and intestinal barrier, contributing to the disease’s pathogenesis.

How does a gluten-free diet affect gut microbiota?

A: A gluten-free diet, while essential for managing celiac disease, significantly alters the gut microbiota’s composition. This diet leads to changes in microbial communities that could influence the disease’s pathogenesis and the overall health of individuals with celiac disease.

What future treatments are being explored for celiac disease?

A: Research is exploring probiotics, prebiotics, and fecal microbiota transplantation (FMT) as potential treatments. These interventions aim to modulate the gut microbiota, offering new strategies to complement the gluten-free diet in managing celiac disease symptoms and reducing disease severity.

Can probiotics and prebiotics be effective in celiac disease treatment?

A: Probiotics and prebiotics show promise in restoring gut microbial balance and enhancing the immune response, potentially serving as adjunct therapies to the gluten-free diet. However, more research is needed to fully understand their efficacy and safety in celiac disease treatment.

Last update: 15 April 2024, 10:10


Gastroenterologist - Hepatologist, Thessaloniki

PhD at Medical School, Aristotle University of Thessaloniki, Greece

PGDip at Universitair Medisch Centrum Utrecht, The Netherlands

Ex President, Hellenic H. pylori & Microbiota Study Group