Up to date view of the pathogenesis of coeliac disease, significance of environmental factors

Prevalence of coeliac disease is approximately 1% in the general population; however, the characteristic genetic constellation is present in about 30% of individuals. In addition to genetic predisposition, the role of the transglutaminase enzyme and gluten is indispensable, the latter being the most significant environmental factor. Other environmental factors are also required for the development of the disease, including mode of delivery, amount of gluten consumption, frequency of infections, and changes in the composition of the intestinal microflora. The latter is considered the most important, as all other factors influence the microflora. An altered microflora is unable to fully metabolize gliadin, a function that even the small intestinal mucosa cannot adequately perform. The latest research results summarized in the paper show that intestinal flora adversely affected by environmental factors cannot fully metabolize gliadin, nor can the human small intestinal mucosa. As a result, gliadin can trigger the autoimmune process leading to celiac disease in individuals who are predisposed to it. As a result, inadequately metabolized gliadin peptides can trigger autoimmune processes in individuals with favourable genetic constellation.