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Management of celiac disease: from evidence to clinical practice

Tiziana M. Attardo, Elena Magnani, Carlotta Casati, Danilo Cavalieri, Pietro Crispino, Federica Fascì Spurio, Stefano De Carli, Daniela Tirotta, Paola Gnerre
  • Elena Magnani
    Department of Internal Medicine, M. Bufalini Hospital, AUSL Romagna, Cesena (FC), Italy
  • Carlotta Casati
    Department of Internal Medicine, Careggi Hospital, Firenze, Italy
  • Danilo Cavalieri
    School of Specialization in Internal Medicine, Campus Bio-Medico University, Roma, Italy
  • Pietro Crispino
    Department of Internal Medicine and Emergency, Lagonegro Hospital, ASP Potenza, Lagonegro (PZ), Italy
  • Federica Fascì Spurio
    Department of Internal Medicine, Dell’Angelo Hospital, Asl 12 Veneziana, Mestre (VE), Italy
  • Stefano De Carli
    Department of Internal Medicine, S. Maria della Misericordia Hospital, Udine, Italy
  • Daniela Tirotta
    Department of Internal Medicine, Cervesi Hospital, AUSL Romagna, Cattolica (RN), Italy
  • Paola Gnerre
    Department of Internal Medicine 2, San Paolo Hospital, Savona, Italy

Abstract

Celiac disease (CD) is a complex polygenic disorder, which involves genetic factors human leukocyte complex (HLA) and non-HLA genes, environmental factors, innate and adoptive immunity, and a robust chronic T-mediated autoimmune component. The main goal of the present monograph is to define a methodological approach for the disease, characterized by frequent late diagnosis, in order for the physician to become aware of the disease management, the diversity of the clinical presentation itself and in different patients. A unique attention is payed to the specific diagnostic tests to define a correct and accurate application of them, and in addition, to disease follow-up and possible complications. Moreover, a dedicated space is assigned to refractory CD, to potential CD and non-celiac gluten sensitivity. Legislative aspects of the celiac disease in Italy are addressed, too. The celiac disease guidelines and their evaluation by means of Appraisal of Guidelines, Research and Evaluation II instrument allow us to classify the different recommendations and to apply them according to the stakeholders’ involvement, pertinence, methodological accuracy, clarity and publishing independence. Finally, the most current scientific evidence is taken into account to create a complete updated monograph.

Keywords

Celiac disease; guidelines; potential and refractory celiac disease; non-celiac gluten sensitivity; Italian legislative aspects of celiac disease.

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Submitted: 2016-12-02 23:03:09
Published: 2017-11-28 14:02:08
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Copyright (c) 2017 Tiziana M. Attardo, Elena Magnani, Carlotta Casati, Danilo Cavalieri, Pietro Crispino, Federica Fascì Spurio, Stefano De Carli, Daniela Tirotta, Paola Gnerre

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