Gluten-sensitive Enteropathy (GSE)
Celiac disease as the classically defined gluten-sensitivity and dermatitis herpetiformis was appended to a broadening definition of gluten sensitivity. The diagnostic "gold standard" of celiac disease is the villus atrophy detected in duodenal biopsies. However, it is now recognized that inflammation of the epithelial tissue of the small intestine precedes atrophy. Early in the disease, gluten elicits T-lymphocyte recognition of gluten hydrolysates (polypeptides of gluten) and gluten peptides bind to mammalian tissue transglutaminase (tTG).
This second interaction results in the production of "self" antibodies to tTG. This increases lymphocytes within the epithelia of the small intestine (Marsh grade 1 and 2) and antibody-tTG complexes seen as deposits. This usually progresses to celiac disease (Marsh grade 3 and 4). The dietary cause of GSE is not limited to wheat gluten; 'glutens' from all known edible cultivars of Triticeae can induce GSE in susceptible individuals (see: Gluten immunochemistry).
There are a large number of medical conditions that result from GSE that can occur prior to the development of celiac disease and might be gluten responsive. While the level of villus atrophy in some cases of GSE may not reach clinical celiac disease recognition, the elevation of cellular immunity is capable of producing disorders more frequently found in celiac disease. Conditions secondary to GSE are important diagnostic criteria for gluten sensitivity when there may be no obvious intestinal abnormality.
| DQ haplotypes -Celiac Diseases | |||||
|---|---|---|---|---|---|
| DQ hap | 2.5 | 2.2 | 7.5 | 8.0 | Other |
| 2.5 | 34 | 22 | 4.0 | 2.0 | 22 |
| 2.2 | 1.1 | 4.0 | 1.1 | 2.9 | |
| 7.5 | 0.3 | 0.0 | 1.3 | ||
| 8.1 | 2.9 | 2.0 | |||
| other | 0.4 | ||||
| DQ haplotypes -Normal Population | |||||
| DQ hap | 2.5 | 2.2 | 7.5 | 8.1 | Other |
| 2.5 | 1.7 | 2.9 | 2.9 | 1.8 | 15.1 |
| 2.2 | 1.2 | 2.4 | 1.6 | 12.8 | |
| 7.5 | 1.2 | 1.5 | 1.3 | ||
| 8.1 | 0.5 | 8.0 | |||
| other | 33.4 | ||||
| Odds ratios | |||||
| DQ hap | 2.5 | 2.2 | 7.5 | 8.1 | Other |
| 2.5 | 20:11 | 8:12 | 1.4:16 | 1.1:1 | 1.5:15 |
| 2.2 | 1:1.1 | 1.6:14 | 1:1.3 | 1:5 | |
| 7.5 | 1:4 | 0 | 1:10 | ||
| 8.1 | 6:13 | 1:4 | |||
| other | 1:100 | ||||
| DQ Types by allele numbers (e.g. 0501) can be found here | |||||
Presentation of GSE is often the result of initial recognition of the secondary condition which in follow-up testing (ATA test, AGA test, HLA-DQ typing, and/or biopsy) recognizes the primary condition. The secondary conditions associated with GSE tend to make late onset celiac disease a systemic phenomena.
Read more about this topic: Gluten Sensitivity