primary prevention of coeliac disease - Associazione Italiana ...

Catassi C, Fasano A, Corazza GR (eds):
Primary prevention of coeliac disease. The
utopia of the new millennium? Perspectives on
Coeliac Disease, vol. 1, AIC Press, pp 43-60
Primary prevention of coeliac disease
by favourable infant feeding practices
1,2 1,3
Anneli Ivarsson , Lars Åke Persson and Olle Hernell 2
1 2
Department of Public Health and Clinical Medicine, Epidemiology and Department
3
of Clinical Sciences, Pediatrics, both at Umeå University, Umeå, Sweden, and ICDDR,B:
Centre for Health and Population Research, Dhaka, Bangladesh.
Coeliac disease is now recognised as a common health problem throughout a large
1-12
part of the world . An effective treatment is available through adherence to a strict
gluten-free diet. Screening studies have revealed that most cases are undiagnosed,
which indicates the need for active case recognition, and possibly also a need for
13-14
screening efforts . However, even when coeliac disease has been diagnosed, the
widespread use of gluten-containing foods makes compliance with the treatment
15
difficult . Clearly, then, it is desirable to explore additional strategies such as primary
prevention.
Family clustering
The risk for coeliac disease is higher in first degree relatives compared to the general
population. In family members of coeliac patients, a prevalence of 10% is often
16
mentioned , and in monozygous twins the concordance rate has been estimated at
17-18 19
70% , or even higher .
Family clustering is generally considered as evidence for a strong genetic influence
in coeliac disease susceptibility. However, the fact that family members share not only
genetics but, in many respects, also the same environment, should be taken into
consideration. This is especially true for monozygous twins, who have a similar
environment not only during childhood, as is the case for most siblings, but also have a
similar environment in utero.
A complex aetiology
The aetiology of coeliac disease is not fully understood, largely as a consequence of
its complexity, although our understanding of different aspects of the disease process is
rapidly increasing. Based on present knowledge, an immunological pathogenesis for
the disease seems most likely. In some genetically susceptible individuals, exposure to
gluten, or related proteins in rye and barley, triggers an errant immune response, which
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