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Dig Dis Sci (2013) 58:30663067 DOI 10.1007/s10620-013-2839-y
EDITORIAL
Risks for Celiac Disease: Bacteria Make It Three
J. I. Keenan A. S. Day
Published online: 27 August 2013 Springer Science+Business Media New York 2013
Although the pathogenesis of celiac disease is now well-described [1], key factors contributing to the timing and pattern of its onset in an individual remain unclear. Thus, despite evidence that nearly every person who develops overt celiac disease expresses human-leucocyte antigen (HLA)DQ2 or HLADQ8, there is still no clear explanation of why only a small number of these genetically pre-disposed individuals will develop celiac disease when exposed to gluten in their diet. This observation strongly suggests that other risk factors are also involved in the aetiology of this disease. In this issue of Digestive Diseases and Sciences, Riddle et al. [2] report the association between recent campylobacter infection and subsequent development of celiac disease that did not generalize to other antecedent infections, as monitored by a medical encounter database.
Several lines of evidence support the hypothesis that infectious insults may contribute to the development of celiac disease. The presence of adherent rod-shaped bacteria in small intestinal biopsies from children with celiac disease, not present in healthy controls, is suggestive of a microbial etiology [3]. Moreover, an association has been reported between infections occurring during the perinatal period [4] and in the rst six months of life [5] with a subsequent increased risk of celiac disease. Intriguingly, one of these studies also reported data that disease risk rose synergistically with increasing exposure to gluten [5].
Breast-feeding reduces rates of enteric infections in early life by several mechanisms [6]. Furthermore, breast-feeding may affect the onset of celiac...