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university of tampere: faculty of medicine and life sciences: research: research centres: celiac disease research center: research focuses:
Faculty of Medicine and Life SciencesUniversity of TampereFaculty of Medicine and Life Sciences
Celiac Disease Research Center

Life-long gluten free diet is challenging

At present, the only treatment option for celiac disease is a lifelong gluten-free diet and in Finland, the adherence to a strict diet is excellent. We have shown that inclusion of oats in the gluten-free diet is safe in celiac disease. Strict adherence to the diet usually results in recovery of the small bowel mucosa and alleviation of symptoms and might also prevent the development of complications related to celiac disease such as osteoporotic fractures and small bowel lymphoma. Notwithstanding these benefits, the stigma of a chronic disorder and the need for major dietary restrictions increases the self-perceived burden of illness and may impair patients’ quality of life. Moreover, despite a long-term gluten-free diet, the symptoms may sometimes persist and consequently even well-treated celiac patients may fail to attain well-being similar to that of the population in general. Furthermore, in a subgroup of patients, small bowel mucosal damage recovers slowly and even half of the patients show ongoing villous atrophy in routine follow-up biopsies taken after one year on a gluten-free diet. The clinical significance of such slow response to the dietary treatment remains unclear. Importantly however, our recent studies from Finland indicate that in celiac patients, in a long run small-bowel mucosas heal and after several years’ treatment, persistent villous atrophy is found only in 4% of the patients and symptomatic truly refractory celiac disease even more rarely (0.3%). Refractory celiac disease imposes a significant burden of morbidity, and the condition is usually resistant to any dietary or immunosupressive therapy and often progresses to an overt intestinal lymphoma and premature death. Whether patients, who have evinced good clinical response to gluten-free diet, but show slow histological response or persistent small-bowel mucosal villous atrophy, carry a similar risk for co-morbidity as truly refractory celiac disease cases remains obscure. In the future, our focus is to optimize the gluten-free dietary treatment and work towards finding new treatment options for celiac disease..

Our selected publications:

Hervonen K, Salmi TT, Ilus T, Paasikivi K, Vornanen M, Laurila K, Lindfors K, Viiri K, Saavalainen P, Collin P, Kaukinen K, Reunala T. Dermatitis herpetiformis refractory to gluten-free dietary treatment. Acta Derm Venereol 2016;96:82-6.

Pekki H, Kurppa K, Mäki M, Huhtala H, Sievänen H, Laurikka K, Collin P, Kaukinen K. Predictors and significance of incomplete mucosal recovery in celiac disease after 1 year on a gluten-free diet. Am J Gastroenterol 2015;110:1078-85.    

See JA, Kaukinen K, Makharia G, Gibson P, Murray JA. Practical insights into gluten-free diets. Nat Rev Gastroenterol Hepatol 2015;12:580-91.

Lähdeaho ML, Kaukinen K, Laurila K, Vuotikak P, Koivurova OP, Kärjä-Lahdensuu T, Marcantonio A, Adelman DC, Mäki M. Attenuation of gluten-induced duodenal mucosla injury in celiac disease: results of a randomized controlled Phase 2 clinical trial of a novel gluteinase ALV003. Gastroenterology 2014;146:1649-58.

 Ilus T, Kaukinen K, Virta LJ, Pukkala E, Collin P. Incidence of malignancies in diagnosed celiac disease patients: a population-based estimate. Am J Gastroenterol 2014;104:1471-1477.  

Kaukinen K, Lindfors K, Mäki M Advances in the treatment of coeliac disease: immunopathogenic perspective. Nat Rev Gastroenterol Hepatol 2014;11:36-44.

Ilus T, Kaukinen K, Virta LJ, Huhtala H, Mäki M, Kurppa K, Heikkinen M, Heikura M, Hirsi E, Jantunen K, Moilanen V, Nielsen C, Puhto M, Pölkki H, Vihriälä I, Collin P. Refractory celiac disease in a country with a high prevalence of clinically diagnosed coeliac disease. Aliment Pharm Ther 2014;39:418-25.  

Kaukinen K, Collin P, Huhtala H, Mäki M. Long-term consumption of oats in adult celiac disease patients. Nutrients 2013;5:4380-9.

Ilus T, Lähdeaho M-L, Salmi T, Haimila K, Partanen J, Saavalainen P, Huhtala H, Mäki M, Collin P, Kaukinen K. Persistent duodenal intraepithelial lymphocytosis despite a long-term strict gluten-free diet in celiac disease. Am J Gastroenterol 2012;107:1563-9. 

Stenman SMM, Venäläinen JI, Lindfors K, Auriola S, Mauriala T, Kaukovirta-Norja A, Jantunen A, Laurila K, Qiao S-W, Sollid LM, Männistö PT, Kaukinen K, Mäki M. Enzymatic detoxification of gluten by germinating wheat proteases: implications for new treatement of celiac disease. Ann Med 2009;41:390-400.

Kaukinen K, Salmi T, Collin P, Huhtala H, Kärjä-Lahdensuu T, Mäki M. Gluten microchallenge with wheat starch-based hydrolysates in coeliac disease patients: a randomized, double-blind, placebo-controlled trail to evaluate safety. Aliment Pharm Ther 2008;28:1240–8. 

Holm K, Mäki M, Vuolteenaho N, Mustalahti K, Ashorn M, Ruuska T, Kaukinen K. Oats in the treatment of childhood coeliac disease: a two-year controlled trial and a long-term clinical follow-up study. Aliment Pharmacol Ther 2006;23:1463-72.

Peräaho M, Collin P, Kaukinen K, Kekkonen L, Miettinen S, Mäki M.. Oats can diversify a gluten-free diet in celiac disease and dermatitis herpetiformis. J Am Diet Assoc, 2004;1148-50.

Collin P, Thorell L, Kaukinen K, Mäki M. The safe threshold for gluten contamination in gluten-free products. Can trace amounts be accepted in the treatment of coeliac disease? Aliment Pharmacol Ther, 2004;19:1277-1283.

Peräaho M, Kaukinen K, Paasikivi K, Sievänen H, Lohiniemi S, Mäki M, Collin P. Wheat-starch-based gluten-free products in the treatment of newly detected celiac disease. Prospective and randomised study. Aliment Pharmacol Ther 2003;17:587-94.


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