Probiotics for Celiac Disease
Celiac Disease (CD) or gluten sensitive enteropathy is anautoimmune disorder characterised by variable presentations which respond to exclusion of wheat and other gluten containing products. While exclusion of gluten is the corner stone in the management ofthis entity, newer therapeutic approaches are now being investigated. These include use of elemental diets, oral prolyl-endopeptidases, IL-15blockage, transamidation of wheat and use of probiotics.
The microbial composition of the gut of patients with active CD isdifferent from healthy controls. In a report assessing the duodenal microbiota in CD it was noted that the ratio of Lactobacillus-Bifidobacterium to Bacteroides-Escherichia coli was lower in children with active CD vis-à-vis healthy controls.
A metabolomic approach to evaluation of changes in microbiota after gluten free diet also suggested similar phenomenon i.e. there storation of microbiota was not complete and that certain molecules could be used as metabolic signatures of CD. Incidentally the oral microbiota of treated CD patients is also disparate from the microbiota of healthy controls. Therefore the bulk of evidence points to an alteration in the microbiota in patients with CD. It is not clear if this modified microbiota is driven by the disease or drives the symptomatology of the disease.
The use of probiotics in celiac disease remains investigational as of now but may provide a therapeutic approach for management of CD in future, The possible targets of use of probiotics include the opportunity to degrade ingested gluten and maintain barrier function of intestine in wake of exposure to gluten.
Journal of Probiotics and Health
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