Pediatric and Adult Celiac Disease: A Clinically Oriented Perspective

For many years, Italian medicine has held a prominent position in the study of celiac disease in both children and adults. Italy has hosted important international symposia, and many Italian scientists have been involved in international consensus groups and guideline development. The amount of scientific research produced in Italy competes with that of the most productive countries. Hence, it is not surprising that this book was conceived and written entirely by Italian authors, including a few who hold prestigious positions in North American institutions. To note, this book does not aim to provide an Italian view on celiac disease, simply because such a view does not exist. The authors belong to independent groups and have gained their expertise at different foreign institutions. As a proof, throughout the book, some controversial opinions on specific topics emerge, as underlined by the editors themselves with appropriate callouts, highlighting controversial areas that may be the object of future research. The main goals of this book are twofold. First, we wanted to provide a clear and up-to-date understanding of childhood and adult celiac disease, useful for all professionals and scientists (e.g., pediatricians, gastroenterologists, internists, pathologists, immunologists and basic scientists, dermatologists, nutritionists, and dieticians) involved in its management. Second, we aimed at having a clinical perspective as a leitmotif, as indicated in the book subtitle. However, this did not deter us from deepening those subtle mechanisms that represent the bases of the disease, since their understanding undoubtedly improves clinical practice. Furthermore, exploring the modalities of presentation of a food antigen known in its molecular structure to the immune system, the enzymatic mechanisms underlying the strengthening of its immunogenicity, the ways of clustering across autoimmune diseases, and the progression from chronic inflammation to lymphoma have made celiac disease a model of paramount importance for understanding broader mechanisms involved in the breakdown of immunological tolerance. Going back to the clinical ground, although the spectrum of clinical presentation is wider and clearer than in the past, this disease never ceases to amaze us. The vast majority of patients are still undiagnosed, or are diagnosed with years of delay, despite the better disease awareness and the availability of accurate diagnostic tools. Recent data suggest that this happens not only in the primary care but also in the secondary care. Also, due to their relevant role in promoting educational and awareness campaigns, in fundraising for research, in supporting patients and their families, and in dealing with stakeholders and socio-political institutions, we have included a chapter dedicated to the activity of the patient association “Associazione Italiana Celiachia” (AIC), member of the AOECS. We think that there is a real need for a new book because, compared to the latest on this topic, a number of novel issues and data have emerged. We will discuss the epidemiology of this constantly increasing condition, along with the many uncertainties around its differentiation from a series of emergent disorders (e.g., nonceliac gluten/wheat sensitivity, olmesartan enteropathy, immunodeficiencies, seronegative celiac disease, wheat allergy) that are yet unclear to many physicians. Furthermore, new guidelines on pediatric celiac disease were published in 2020 and the appropriateness of a biopsy-free approach in adults is still disputed. Finally, we report here for the first time a critical reappraisal of nondietary treatments, as well as the results of the recent phase II IV trials focusing on refractory celiac disease and enteropathy-associated T-cell lymphoma. To conclude, the editors would like to express their deepest gratitude to Tracy Tufaga, Stacy Masucci, and all the Elsevier editorial staff for their valuable assistance.