The aetiology of coeliac disease and its significance for therapy

The enzymopathic hypothesis of the aetiology of coeliac disease (CD) is still relevant as a mechanism operating in this disease and a form of therapy based on the use of enzymes which are deficient in CD is currently being evaluated. This approach is based on the premise that if gluten and other offending proteins are completely digested in the small intestinal mucosa with the aid of supplementary enzymes, an adverse response will not occur. This is comparable to the situation in those who do not suffer from this disease, where there is neither direct toxic action nor an abnormal immunological response to cause damage to the mucosa. Enzyme therapy offers a way of safeguarding the integrity of the small intestine for patients against traces of gluten ingested whilst attempting to maintain a strict gluten-free diet. Furthermore, in the future, the efficiency of this approach may develop to the point where minor indulgence in some favourite foods and beverages, may be possible.