Alimentary Pharmacology and Therapeutics

Editorial: coeliac disease – pathogenesis, prognosis and management

The international prevalence of coeliac disease is increasing and has been the subject of a comprehensive review showing geographical variation in prevalence.1 The reasons behind higher rates of coeliac disease within populations continue to be debated; alterations in infant feeding have been proposed, and recently reviewed in relation to breast feeding and weaning practices.2 The identification and diagnosis of coeliac disease is becoming increasingly important as researchers are demonstrating a greater number of associated health risks. Higher levels of mortality from cardiovascular disease have been demonstrated in people with coeliac disease compared to controls in Sweden, irrespective of a more favourable profile of traditional risk factors linked to ischaemic heart disease.3 It has been suggested that this increased risk may be due in part to some vascular impairment with chronic inflammation playing a role.4 Associated health risks are confounded in people with coeliac disease by the necessity to adhere to a gluten-free diet. The diet has been shown to be higher compared to population controls in total and saturated fat, significantly higher in males but not females, and significantly higher in kilojoules, after 1 year of gluten exclusion.5 It is noteworthy that differences and inadequacies in dietary intake are not mirrored to the same extent in children.6 Diet is the cornerstone to managing coeliac disease and promotion of adherence to a gluten-free diet is fundamental; it is therefore essential to understand individuals’ experiences. Those on a gluten-free diet have reported issues concerning both practical and emotional issues of living with a gluten restriction.7, 8 A survey from the USA concluded that people with coeliac disease have a diminished quality of life, especially in relation to social activities,7 and this was reinforced by a grounded theory study illuminating the effect of dietary restrictions on personal identity.8 Healthcare services therefore need to be organised to support people through diagnosis and management. It has been reported that some people with coeliac disease can suffer symptoms up to 25 years prior to diagnosis9 and have difficulties adhering to dietary restrictions. The availability of gluten-free products on prescription is a controversial area of management in coeliac disease. Under-prescribing of gluten-free products was identified in a review of electronic patient records in Scotland.9 However, the authors concluded that further research is required to establish prescribing patterns for the whole of the United Kingdom. This virtual issue brings together a selection of contemporary articles on coeliac disease facilitating an overview of original studies, both qualitative and quantitative, along with systematic reviews giving an exciting insight into current research. This is combined with a view to future developments in the management of coeliac disease.10

ª 2014 John Wiley & Sons Ltd doi:10.1111/apt.12679

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Editorial ACKNOWLEDGEMENT Declaration of personal and funding interests: None.

REFERENCES 1. Kang JY, Kang AH, Green A, Gwee KA, Ho KY. Systematic review: worldwide variation in the frequency of coeliac disease and changes over time. Aliment Pharmacol Ther 2013; 38: 226–45. 2. Szajewska H, Chmielewska A, Piescik-Lech M, et al. Systematic review: early infant feeding and the prevention of coeliac disease. Aliment Pharmacol Ther 2012; 36: 607–18. 3. Emilsson L, Carlsson R, Holmqvist M, James S, Ludvigsson JF. The characterisation and risk factors of ischaemic heart disease in patients with coeliac disease. Aliment Pharmacol Ther 2013; 37: 905–14. 4. De Marchi S, Chiarioni G, Prior M, Arosio E. Young adults with coeliac disease may be at increased risk of early atherosclerosis. Aliment Pharmacol Ther 2013; 38: 162–9. 5. Shepherd SJ, Gibson PR. Nutritional inadequacies of the gluten-free diet in both recentlydiagnosed and long-term patients with coeliac disease. J Hum Nutr Diet 2013; 26: 349–58. 6. Kautto E, Ivarsson A, Norstr€ om F, H€ ogberg L, Carlsson A, H€ ornell A. Nutrient intake in adolescent girls and boys diagnosed with coeliac disease at an early age is mostly comparable to their non-coeliac contemporaries. J Hum Nutr Diet 2014; 27: 41–53. 7. Lee AR, Ng DL, Diamond B, Ciaccio EJ, Green PHR. Living with coeliac disease: survey results from the USA. J Hum Nutr Diet 2012; 25: 233–8. 8. Rose C, Howard R. Living with coeliac disease: a grounded theory study. J Hum Nutr Diet 2014; 27: 30–40. 9. Martin U, Mercer SW. A comparison of general practitioners prescribing of gluten-free foods for the treatment of coeliac disease with national prescribing guidelines. J Hum Nutr Diet 2014; 27: 96–104. 10. Rashtak S, Murray JA. Review article: coeliac disease, new approaches to therapy. Aliment Pharmacol Ther 2012; 35: 768–81.

S. Burden*, S. Langley-Evans*, R. Pounder † & N. Talley † *Journal of Human Nutrition and Dietetics. Alimentary Pharmacology & Therapeutics.



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Aliment Pharmacol Ther 2014; 39: 555-556 ª 2014 John Wiley & Sons Ltd

Editorial: coeliac disease - pathogenesis, prognosis and management.

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