The Indian Council of Medical Research (ICMR) has issued guidelines on diagnosis and management of celiac disease which will help physicians, pathologists, nutritionists and other related disciplines to take care of these patients in an efficient and scientific manner. Besides, these guidelines will serve to rationalise the treatment of celiac disease in the country as well as serve as a reference for the postgraduate students interested in this area.
Celiac disease has been increasingly reported from several states of north India. Recognising its importance, ICMR constituted a Task Force on Celiac disease which recommended that ICMR should develop guidelines for the diagnosis and management of celiac disease in India. This need was felt since in India tropical enteropathy or environmental enteropathy is widely prevalent, and the incidence of parasitic and other infections of the small intestine is also significant. This meant that guidelines for management of celiac disease which are available internationally, have to be customised for the Indian conditions. Hence this activity of formulating Indian Guidelines was undertaken by the expert group.
Celiac disease (CeD) is a chronic immune-mediated enteropathy, which is caused in genetically susceptible individuals by ingestion of gluten proteins present in wheat, barley and rye. CeD was originally described as a disease causing chronic diarrhoea and malabsorption. Flattening of the villi, inflammatory cell infiltration in the mucosa and loss of surface area were the major reasons for the clinical manifestations. The understanding that this is an immune process in which the intestinal epithelium is damaged is now well accepted.
Following from the original descriptions by Willem Karel Dicke relating wheat consumption to CeD, a large number of studies have now established the central role played by proteins from wheat, barley and rye. The disease occurs only in individuals with a certain genetic predisposition, but at the same time it does not necessarily occur in all such individuals. The nature of the immunological response to gluten is still being unravelled and T lymphocytes appear to play the primary role. It is believed that CD4(+) T cells recognize gluten peptides bound to predisposing HLA-DQ molecules (DQ2 and DQ8), particularly when the gluten peptides are deamidated by the enzyme transglutaminase 2 (TG2). However, CeD is also characterized by the production of antibodies to gluten as well as to TG2, and a role for B cells in Celiac disease pathogenesis is receiving increased recognition. Thus the precise definition of CeD incorporates all these characteristics, including the immune nature of the disease.