**Advanced Therapies in Celiac Disease**

136 Celiac Disease – From Pathophysiology to Advanced Therapies

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**8** 

*Australia* 

**Enzyme Therapy for Coeliac Disease:** 

Coeliac disease (CD) is a form of gluten intolerance in which the small bowel is damaged by proteins present in wheat, rye, barley and some varieties of oats (Mäki & Collin, 1997). . These proteins cause severe damage to the duodenum and jejunum (villous atrophy) and can produce a variety of symptoms such as abdominal pain and cramping, bloating

The discovery of the disease by Dicke led to treatment by means of a gluten-free diet, which needs to be maintained for the rest of life (Dicke et al, 1953). If left untreated, severe malabsorption causes the loss of vital nutrients, resulting in conditions such as osteoporosis. In addition, anaemia and long-term immune and autoimmune mechanisms can induce

Diagnosis thus needs to be effected early in life and screening tests are available that are based on antibodies to tissue transglutaminase. If positive, biopsies are necessary to confirm

In people of European descent about one in 100 people suffer from CD, but the disease is considerably under-diagnosed. This is partly because, over the last two decades, the symptoms have changed and become more covert (van Heel & West, 2006). Hence, it is vital that the correct diagnosis be made, taking advantage of serology and endoscopic biopsy, and if positive, a gluten free diet commenced. In addition, we recommend that enzyme supplementation be utilized in order to hasten repair to tissue and help to begin a greatly

The background to our work on enzyme therapy began with studies of etiology of CD and were essentially of a biochemical nature. Although treatment with a gluten-free diet had been hailed as a major breakthrough in patient management, the disease was still poorly understood and further studies were considered absolutely necessary. Like other studies of CD, they were based on showing that the proteins in the gluten fraction of wheat were the causative agents (Anderson et al, 1952). Later, Frazer et al, (1959) showed that a peptictryptic digest of gluten was still toxic to patients with CD and obtained an indication that this toxicity was abolished by further treatment of the digest with an extract of hog mucosa,

**1. Introduction** 

diarrhoea, nausea and lethargy.

lymphomas (van Heel & West, 2006) .

the diagnosis of CD (Sollid, 2002).

improved lifestyle (Cornell & Stelmasiak, 2007).

**Is it Ready for Prime Time?** 

Hugh J. Cornell1 and Teodor Stelmasiak2

*1RMIT University, Melbourne, 2Glutagen Pty Ltd, Maribyrnong,* 
