Are We Close to a Treatment for Celiac Disease?

Q: Has scientific research made any progress toward a cure or treatment for celiac disease?

Until about 15 years ago, pharmaceutical companies showed little interest in drug development for celiac disease, said Dr. Alessio Fasano, director of the Center for Celiac Research and Treatment at Massachusetts General Hospital in Boston. At the time, researchers knew that for those with the condition, consuming gluten — a protein found in wheat, rye and barley — caused damage to the small intestine. But they didn’t understand how or why gluten had this effect. And, Dr. Fasano said, it seemed there was already a simple way to manage celiac disease: adopt a gluten-free diet.

For the estimated 1 percent of people who have this autoimmune condition, avoiding gluten is currently the only method for thwarting small intestine damage and relieving the various symptoms of the disease, which can include abdominal pain, diarrhea, constipation, depression, fatigue, headache, a blistery skin rash and iron-deficiency anemia.

But consuming even minuscule amounts of gluten — just a bread crumb from a cutting board, for example — can re-trigger symptoms and intestinal damage. And maintaining a strict, lifelong gluten-free diet in a world full of hidden gluten-containing ingredients requires constant vigilance and makes eating out, traveling and going to school risky and anxiety-provoking, Dr. Fasano said.

In a survey published in 2014, 341 people with celiac disease rated the burden of managing their condition as worse than those who had chronic acid reflux or high blood pressure, and similar to those who lived with diabetes or kidney disease that required dialysis. Despite trying to avoid gluten, as many as 30 percent of people with celiac disease still have symptoms, said Dr. Elena Verdú, a professor of gastroenterology at McMaster University in Ontario, Canada.

Gluten-free foods can also be more expensive than their gluten-containing counterparts, and many people don’t have access to the support of a dietitian to help them plan a balanced, gluten-free diet, Dr. Verdú said.

As it’s become clearer that maintaining a gluten-free diet is neither simple nor satisfactory for many celiac patients, researchers have also made recent strides in grasping how the disease works. We now understand “almost step-by-step the march, the progress from the moment in which you break down gluten to the point in which you destroy your intestine,” Dr. Fasano said. “An entire world opens up in terms of new treatments.”