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Was ist gesichert in der Therapie der Zöliakie?

What is established in the management of celiac disease?

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Zusammenfassung

Zöliakie ist als eine durch Gluten als Krankheitstrigger induzierte Autoimmunerkrankung inzwischen gut in der Inneren Medizin etabliert. Fraglos genauso gut etabliert ist die glutenfreie Diät als bislang einzig anerkannte Therapie der Zöliakie. Diese bietet in ihrer Durchführung allerdings einige Fallstricke, auf die im vorliegenden Beitrag eingegangen wird. Zudem werden aktuelle Entwicklungen beschrieben, die das Potenzial haben, sowohl die Diagnostik als auch die Therapie der Zöliakie deutlich zu verändern. Ein solcher Ausblick ist einerseits angezeigt, weil die Kollegen vorbereitet sein wollen, wenn solche Entwicklungen in den klinischen Alltag integriert werden. Andererseits hat die Erkenntnis, dass sich das Feld der mukosalen Immunologie bewegt, das Potenzial, die Stimmung des Lesers zu heben.

Abstract

Nowadays, celiac disease is well-established in internal medicine as an autoimmune disease induced by gluten as a trigger. Undoubtedly similarly well-established is the gluten-free diet. It is the only recognized therapy for celiac disease to date. However, this presents some pitfalls in its implementation, which will be discussed in the following review. In addition, current developments that have the potential to significantly change both diagnosis and treatment of celiac disease are discussed. On the one hand, such an outlook was chosen since colleagues want to be “ready” when such developments are integrated into daily clinical routine. On the other hand, the realization that the field of mucosal immunology is moving forward has the potential to lift the spirits of the reader.

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Literatur

  1. Felber J, Blaker H, Fischbach W et al (2022) Aktualisierte S2k-Leitlinie Zöliakie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). Z Gastroenterol 60:790–856

    Article  PubMed  Google Scholar 

  2. Rubio-Tapia A, Hill ID, Kelly CP et al (2013) ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol 108:656–676 (quiz 677)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Husby S, Koletzko S, Korponay-Szabó IR et al (2012) European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 54:136–160

    Article  CAS  PubMed  Google Scholar 

  4. Catassi C, Fabiani E, Iacono G et al (2007) A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease. Am J Clin Nutr 85:160–166

    Article  CAS  PubMed  Google Scholar 

  5. Alimentarius C (2008) Standard for foods for special dietary use for persons intolerant to gluten. CXS 118–1979

    Google Scholar 

  6. Collin P, Thorell L, Kaukinen K et al (2004) The safe threshold for gluten contamination in gluten-free products. Can trace amounts be accepted in the treatment of coeliac disease? Aliment Pharmacol Ther 19:1277–1283

    Article  CAS  PubMed  Google Scholar 

  7. Osorio CE, Mejias JH, Rustgi S (2019) Gluten detection methods and their critical role in assuring safe diets for celiac patients. Nutrients 11:

  8. Zarkadas M, Dubois S, MacIsaac K et al (2013) Living with coeliac disease and a gluten-free diet: a Canadian perspective. J Hum Nutr Diet 26:10–23

    Article  CAS  PubMed  Google Scholar 

  9. Miller K, McGough N, Urwin H (2016) Catering gluten-free when simultaneously using wheat flour. J Food Prot 79:282–287

    Article  PubMed  Google Scholar 

  10. Vincentini O, Izzo M, Maialetti F et al (2016) Risk of cross-contact for gluten-free pizzas in shared-production restaurants in relation to oven cooking procedures. J Food Prot 79:1642–1646

    Article  CAS  PubMed  Google Scholar 

  11. Studerus D, Hampe EI, Fahrer D et al (2018) Cross-contamination with gluten by using kitchen utensils: fact or fiction? J Food Prot 81:1679–1684

    Article  PubMed  Google Scholar 

  12. Weisbrod VM, Silvester JA, Raber C et al (2020) Preparation of gluten-free foods alongside gluten-containing food May not always be as risky for celiac patients as diet guides suggest. Gastroenterology 158:273–275

    Article  PubMed  Google Scholar 

  13. Parsons K, Brown L, Clark H et al (2021) Gluten cross-contact from common food practices and preparations. Clin Nutr 40:3279–3287

    Article  CAS  PubMed  Google Scholar 

  14. Goel G, Tye-Din JA, Qiao SW et al (2019) Cytokine release and gastrointestinal symptoms after gluten challenge in celiac disease. Sci Adv 5:eaaw7756

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Stefanolo JP, Talamo M, Dodds S et al (2021) Real-world gluten exposure in patients with celiac disease on gluten-free diets, determined from gliadin immunogenic peptides in urine and fecal samples. Clin Gastroenterol Hepatol 19:484–491e1

    Article  CAS  PubMed  Google Scholar 

  16. Sainsbury A, Sanders DS, Ford AC (2013) Prevalence of irritable bowel syndrome-type symptoms in patients with celiac disease: a meta-analysis. Clin Gastroenterol Hepatol 11:359–365e1

    Article  PubMed  Google Scholar 

  17. Miletic ID, Miletic VD, Sattely-Miller EA et al (1994) Identification of gliadin presence in pharmaceutical products. J Pediatr Gastroenterol Nutr 19:27–33

    Article  CAS  PubMed  Google Scholar 

  18. Pinto-Sánchez MI, Causada-Calo N, Bercik P et al (2017) Safety of adding oats to a gluten-free diet for patients with celiac disease: systematic review and meta-analysis of clinical and observational studies. Gastroenterology 153:395–409.e3

    Article  PubMed  Google Scholar 

  19. Wieser H, Segura V, Ruiz-Carnicer A et al (2021) Food safety and cross-contamination of gluten-free products: a narrative review. Nutrients 13:

  20. Peräaho M, Collin P, Kaukinen K et al (2004) Oats can diversify a gluten-free diet in celiac disease and dermatitis herpetiformis. J Am Diet Assoc 104:1148–1150

    Article  PubMed  Google Scholar 

  21. Wolf RL, Lebwohl B, Lee AR et al (2018) Hypervigilance to a gluten-free diet and decreased quality of life in teenagers and adults with celiac disease. Dig Dis Sci 63:1438–1448

    Article  PubMed  Google Scholar 

  22. Gholmie Y, Lee AR, Satherley R‑M et al (2023) Maladaptive food attitudes and behaviors in individuals with celiac disease and their association with quality of life. Dig Dis Sci. https://doi.org/10.1007/s10620-023-07912-6

    Article  PubMed  PubMed Central  Google Scholar 

  23. Cardo A, Churruca I, Lasa A et al (2021) Nutritional imbalances in adult celiac patients following a gluten-free diet. Nutrients 13:

  24. Leffler DA, Schuppan D (2010) Update on serologic testing in celiac disease. Am J Gastroenterol 105:2520–2524

    Article  PubMed  Google Scholar 

  25. Volta U, Granito A, Parisi C et al (2010) Deamidated gliadin peptide antibodies as a routine test for celiac disease: a prospective analysis. J Clin Gastroenterol 44:186–190

    Article  PubMed  Google Scholar 

  26. Werkstetter KJ, Korponay-Szabo IR, Popp A et al (2017) Accuracy in diagnosis of celiac disease without biopsies in clinical practice. Gastroenterology 153:924–935

    Article  PubMed  Google Scholar 

  27. Nachman F, Sugai E, Vazquez H et al (2011) Serological tests for celiac disease as indicators of long-term compliance with the gluten-free diet. Eur J Gastroenterol Hepatol 23:473–480

    PubMed  Google Scholar 

  28. Vahedi K, Mascart F, Mary JY et al (2003) Reliability of antitransglutaminase antibodies as predictors of gluten-free diet compliance in adult celiac disease. Am J Gastroenterol 98:1079–1087

    Article  CAS  PubMed  Google Scholar 

  29. Murray JA (2023) To biopsy or not to biopsy: that is the question. Gut. https://doi.org/10.1136/gutjnl-2020-320593

    Article  PubMed  Google Scholar 

  30. Schiepatti A, Maimaris S, Raju SA et al (2023) Persistent villous atrophy predicts development of complications and mortality in adult patients with coeliac disease: a multicentre longitudinal cohort study and development of a score to identify high-risk patients. Gut

  31. Leffler DA, Edwards GJB, Dennis M et al (2007) A prospective comparative study of five measures of gluten-free diet adherence in adults with coeliac disease. Aliment Pharmacol Ther 26:1227–1235

    Article  CAS  PubMed  Google Scholar 

  32. Leffler DA, Dennis M, Edwards GJB et al (2009) A simple validated gluten-free diet adherence survey for adults with celiac disease. Clin Gastroenterol Hepatol 7:530–536.e1–2

    Article  PubMed  Google Scholar 

  33. Moreno ML, Cebolla A, Munoz-Suano A et al (2017) Detection of gluten immunogenic peptides in the urine of patients with coeliac disease reveals transgressions in the gluten-free diet and incomplete mucosal healing. Gut 66:250–257

    Article  CAS  PubMed  Google Scholar 

  34. Ruiz-Carnicer A, Garzon-Benavides M, Fombuena B et al (2020) Negative predictive value of the repeated absence of gluten immunogenic peptides in the urine of treated celiac patients in predicting mucosal healing: new proposals for follow-up in celiac disease. Am J Clin Nutr 112:1240–1251

    Article  PubMed  Google Scholar 

  35. Goel G, King T, Daveson AJ et al (2017) Epitope-specific immunotherapy targeting CD4-positive T cells in coeliac disease: two randomised, double-blind, placebo-controlled phase 1 studies. Lancet Gastroenterol Hepatol 2:479–493

    Article  PubMed  PubMed Central  Google Scholar 

  36. Kelly CP, Murray JA, Leffler DA et al (2021) TAK-101 nanoparticles induce gluten-specific tolerance in celiac disease: a randomized, double-blind, placebo-controlled study. Gastroenterology 161:66–80.e8

    Article  CAS  PubMed  Google Scholar 

  37. Freitag TL, Podojil JR, Pearson RM et al (2020) Gliadin Nanoparticles induce immune tolerance to Gliadin in mouse models of celiac disease. Gastroenterology 158:1667–1681.e12

    Article  CAS  PubMed  Google Scholar 

  38. Pultz IS, Hill M, Vitanza JM et al (2021) Gluten degradation, pharmacokinetics, safety, and tolerability of TAK-062, an engineered enzyme to treat celiac disease. Gastroenterology 161:81–93.e3

    Article  CAS  PubMed  Google Scholar 

  39. Schuppan D, Maki M, Lundin KEA et al (2021) A randomized trial of a transglutaminase 2 inhibitor for celiac disease. N Engl J Med 385:35–45

    Article  CAS  PubMed  Google Scholar 

  40. Vicari AP, Schoepfer AM, Meresse B et al (2017) Discovery and characterization of a novel humanized anti-IL-15 antibody and its relevance for the treatment of refractory celiac disease and eosinophilic esophagitis. mAbs 9:927–944

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Correspondence to Michael Schumann.

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D. Studerus und M. Schumann geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Hermann Haller, Hannover

Kai Schmidt-Ott, Hannover

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Studerus, D., Schumann, M. Was ist gesichert in der Therapie der Zöliakie?. Innere Medizin 64, 1162–1170 (2023). https://doi.org/10.1007/s00108-023-01621-y

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