Celiac disease: an underappreciated issue in women’s health

Abstract

Celiac disease (CD) is an immune-mediated enteropathy that is secondary to gluten ingestion and classically associated with gastrointestinal symptoms. Diagnosis is based on serology and confirmatory duodenal biopsy, and the only treatment is lifelong avoidance of gluten. CD has been increasingly recognized to encompass a wide variety of manifestations that are relevant to women’s health, including infertility, adverse pregnancy outcomes and reduced BMD. Currently, CD is underdiagnosed, largely owing to lack of recognition of the diverse manifestations by general practitioners. Increased awareness of the clinical spectrum of this disease, as well as targeted testing in at-risk individuals (including women with unexplained infertility and previous adverse pregnancy outcomes, and in specific populations with reduced BMD) is greatly needed in order to improve rates of diagnosis.

Figure 1. Pathogenesis of celiac disease

Gluten peptides are deaminated by tTG and bind HLA-DQ2 and HLA-DQ8 molecules. Antigen-presenting cells activate helper T cells and trigger an inflammatory reaction causing activation of cytotoxic T cells, macrophages and plasma cells. The result is mucosal disruption, matrix remodeling, cell death and the production of antibodies to gliadin and tTG. tTG: Tissue transglutaminase.