Non-dietary forms of treatment for adult celiac disease

Core Tip

Core tip: Non-dietary forms of treatment for adult celiac disease are currently being evaluated and some have reached clinical trials. Some novel approaches being investigated include hydrolysis of gliadin peptides, inhibition of intestinal permeability, blockade of T lymphocytes and transglutaminase 2/human leukocyte antigen-DQ2 functions as well as induction of immune tolerance. Future evaluations will need to define effects on specific endpoints and ensure an improvement in symptoms, laboratory test results and, most important, mucosal inflammatory changes. Therapeutic trials with novel agents will be difficult from an ethical perspective as the current form of management with a gluten-free diet already provides an excellent result for most compliant patients with celiac disease. Finally, effects on other known superimposed diseases will need close evaluation (i.e., lymphoproliferative and other malignancies).