Society for the Study of Celiac Disease position statement on gaps and opportunities in coeliac disease

Abstract

Progress has been made in understanding coeliac disease, a relatively frequent and underappreciated immune-mediated condition that occurs in genetically predisposed individuals. However, several gaps remain in knowledge related to diagnosis and management. The gluten-free diet, currently the only available management, is not curative or universally effective (some adherent patients have ongoing duodenal injury). Unprecedented numbers of emerging therapies, including some with novel tolerogenic mechanisms, are currently being investigated in clinical trials. In March 2020, the Celiac Disease Foundation and the Society for the Study of Celiac Disease convened a consensus workshop to identify high-yield areas of research that should be prioritized. Workshop participants included leading experts in clinical practice, academia, government and pharmaceutical development, as well as representatives from patient support groups in North America. This Roadmap summarizes key advances in the field of coeliac disease and provides information on important discussions from the consensus approach to address gaps and opportunities related to the pathogenesis, diagnosis and management of coeliac disease. The morbidity of coeliac disease is often underestimated, which has led to an unmet need to improve the management of these patients. Expanded research funding is needed as coeliac disease is a potentially curable disease.

Abstract

Coeliac disease is a serious condition and a model disease that can shed light into the mechanisms that underlie autoimmunity and chronic inflammation. This Roadmap summarizes key advances in coeliac disease and provides recommendations from a consensus workshop to address the gaps and opportunities in the pathogenesis, diagnosis and management of coeliac disease, providing a path forward.

Key points

• Coeliac disease is a common and serious medical condition that is under-recognized among the health-care provider community, government and the public.

• This Roadmap summarizes consensus recommendations to address gaps and opportunities in pathogenesis, diagnosis and management of coeliac disease.

• Various animal models are available to translate hypotheses generated from human studies, and progress is being made in the development of physiological coeliac epithelial models based on organoid technology.

• Coeliac-specific serology is highly reliable for the diagnosis of coeliac disease; however, there is disagreement between experts as to the necessity of intestinal biopsy to confirm the diagnosis.

• There is increasing need for development of programmes for proper clinical management of coeliac disease, and the number of potential therapeutic targets and clinical trials has grown exponentially over the past 15 years.

• Increased funding for coeliac disease research is crucial to improve clinical management and facilitate development of therapies for this condition.