Editing Coeliac disease (section)

==Causes==
Coeliac disease is caused by an inflammatory reaction to [[gliadin]]s and [[glutenin]]s ([[gluten]] proteins)<ref name=KupferJabri2012>{{cite journal | vauthors = Kupfer SS, Jabri B | title = Pathophysiology of celiac disease | journal = Gastrointestinal Endoscopy Clinics of North America | volume = 22 | issue = 4 | pages = 639–660 | date = October 2012 | pmid = 23083984 | pmc = 3872820 | doi = 10.1016/j.giec.2012.07.003 | type = Review | quote = Gluten comprises two different protein types, gliadins and glutenins, capable of triggering disease. }}</ref> found in wheat and to similar proteins found in the crops of the [[tribe (biology)|tribe]] [[Triticeae]] (which includes other common grains such as [[barley]] and [[rye]])<ref name=Lancet2009/> and to the tribe [[Aveneae]] ([[oat]]s).<ref name=Biesiekierski2017>{{cite journal | vauthors = Biesiekierski JR | title = What is gluten? | journal = Journal of Gastroenterology and Hepatology | volume = 32 | issue = Suppl 1 | pages = 78–81 | date = March 2017 | pmid = 28244676 | doi = 10.1111/jgh.13703 | quote = Similar proteins to the gliadin found in wheat exist as secalin in rye, hordein in barley, and avenins in oats and are collectively referred to as "gluten." Derivatives of these grains such as triticale and malt and other ancient wheat varieties such as spelt and kamut also contain gluten. The gluten found in all of these grains has been identified as the component capable of triggering the immune-mediated disorder, coeliac disease. | doi-access = free }}</ref> Wheat subspecies (such as [[spelt]], [[durum]], and [[Kamut]]) and wheat hybrids (such as [[triticale]]) also cause symptoms of coeliac disease.<ref name=Biesiekierski2017 /><ref name=Kupper>{{cite journal | vauthors = Kupper C | title = Dietary guidelines and implementation for celiac disease | journal = Gastroenterology | volume = 128 | issue = 4 Suppl 1 | pages = S121–S127 | date = April 2005 | pmid = 15825119 | doi = 10.1053/j.gastro.2005.02.024 | doi-access = free }}</ref>

A small number of people with coeliac disease react to oats.<ref name=Lancet2009/> Oat toxicity in coeliac people depends on the oat [[cultivar]] consumed because the prolamin genes, protein amino acid sequences, and the [[immunoreactivity|immunoreactivities]] of toxic prolamins are different in different oat varieties.<ref name=CominoMoreno2015/><ref name=PenaginiDilillo>{{cite journal |vauthors=Penagini F, Dilillo D, Meneghin F, Mameli C, Fabiano V, Zuccotti GV |title=Gluten-free diet in children: an approach to a nutritionally adequate and balanced diet |journal=Nutrients |volume=5 |issue=11 |pages=4553–65 |date=18 November 2013 |pmid=24253052 |pmc=3847748 |doi=10.3390/nu5114553 |doi-access=free}}</ref> Also, oats are frequently cross-contaminated with other grains containing gluten.<ref name=CominoMoreno2015 /><ref name=PenaginiDilillo /><ref name=DeSouzaDeschenes2016>{{cite journal |vauthors=de Souza MC, Deschênes ME, Laurencelle S, Godet P, Roy CC, Djilali-Saiah I |title=Pure Oats as Part of the Canadian Gluten-Free Diet in Celiac Disease: The Need to Revisit the Issue. |journal=Can J Gastroenterol Hepatol |year=2016 |volume=2016 |pages=1–8 |pmid=27446824 |doi=10.1155/2016/1576360 |pmc=4904650 |type=Review |doi-access=free}}</ref> The term "pure oats" refers to oats uncontaminated with other gluten-containing cereals.<ref name=CominoMoreno2015 /> The long-term effects of pure oat consumption are still unclear,<ref name=HaboubiTaylor2006>{{cite journal |vauthors=Haboubi NY, Taylor S, Jones S |title=Coeliac disease and oats: a systematic review |journal=Postgrad Med J |volume=82 |issue=972 |pages=672–8 |date=October 2006 |pmid=17068278 |pmc=2653911 |doi=10.1136/pgmj.2006.045443 |type=Review}}</ref> and further studies identifying the cultivars used are needed before making final recommendations on their inclusion in a [[gluten-free diet]].<ref name=DeSouzaDeschenes2016 /> Coeliac people who choose to consume oats need a more rigorous lifelong follow-up, possibly including periodic [[#Endoscopy|intestinal biopsies]].<ref name=HaboubiTaylor2006 />

===Other grains===
Other cereals such as [[maize|corn]], [[millet]], [[sorghum]], [[teff]], [[rice]], and [[wild rice]] are safe for people with coeliac disease to consume, as well as non-cereals such as [[amaranth]], [[quinoa]], and [[buckwheat]].<ref name=Kupper/><ref>{{Cite book | vauthors = Gallagher E |title=Gluten-free Food Science and Technology |publisher=Published by John Wiley and Sons |year=2009 |page=320 |isbn=978-1-4051-5915-9 |url=http://eu.wiley.com/WileyCDA/WileyTitle/productCd-1405159154.html |url-status=live |archive-url=https://web.archive.org/web/20090617114337/http://eu.wiley.com/WileyCDA/WileyTitle/productCd-1405159154.html |archive-date=17 June 2009}}</ref> Noncereal carbohydrate-rich foods such as potatoes and bananas do not contain gluten and do not trigger symptoms.<ref name=Kupper/>

===Risk modifiers===
There are various theories as to what determines whether a genetically susceptible individual will go on to develop coeliac disease. Major theories include surgery, pregnancy, infection and emotional stress.<ref name=Glutengovca>{{cite web |title=The Gluten Connection |url=https://www.canada.ca/en/health-canada/services/food-nutrition/reports-publications/food-safety/celiac-disease-gluten-connection-1.html |publisher=Health Canada |access-date=1 October 2013 |url-status=live |archive-url=https://web.archive.org/web/20170705183625/https://www.canada.ca/en/health-canada/services/food-nutrition/reports-publications/food-safety/celiac-disease-gluten-connection-1.html |archive-date=5 July 2017 |date=May 2009}}</ref>

The eating of gluten early in a baby's life does not appear to increase the risk of coeliac disease but later introduction after six months may increase it.<ref>{{cite journal |vauthors=Pinto-Sánchez MI, Verdu EF, Liu E, Bercik P, Green PH, Murray JA, Guandalini S, Moayyedi P |title=Gluten Introduction to Infant Feeding and Risk of Celiac Disease: Systematic Review and Meta-Analysis |journal=The Journal of Pediatrics |volume=168 |pages=132–43.e3 |date=January 2016 |pmid=26500108 |doi=10.1016/j.jpeds.2015.09.032 |doi-access=free}}</ref><ref>{{cite journal |vauthors=Ierodiakonou D, Garcia-Larsen V, Logan A, Groome A, Cunha S, Chivinge J, Robinson Z, Geoghegan N, Jarrold K, Reeves T, Tagiyeva-Milne N, Nurmatov U, Trivella M, Leonardi-Bee J, Boyle RJ |title=Timing of Allergenic Food Introduction to the Infant Diet and Risk of Allergic or Autoimmune Disease: A Systematic Review and Meta-analysis |journal=JAMA |volume=316 |issue=11 |pages=1181–1192 |date=September 2016 |pmid=27654604 |doi=10.1001/jama.2016.12623 |hdl=10044/1/40479 |hdl-access=free}}</ref> There is uncertainty whether being breastfed reduces risk. Prolonging [[breastfeeding]] until the introduction of gluten-containing grains into the diet appears to be associated with a 50% reduced risk of developing coeliac disease in infancy; whether this persists into adulthood is not clear.<ref>{{cite journal |vauthors=Akobeng AK, Ramanan AV, Buchan I, Heller RF |title=Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies |journal=Archives of Disease in Childhood |volume=91 |issue=1 |pages=39–43 |date=January 2006 |pmid=16287899 |pmc=2083075 |doi=10.1136/adc.2005.082016}}</ref> These factors may just influence the timing of onset.<ref>{{cite journal |vauthors=Lionetti E, Castellaneta S, Francavilla R, Pulvirenti A, Tonutti E, Amarri S, Barbato M, Barbera C, Barera G, Bellantoni A, Castellano E, Guariso G, Limongelli MG, Pellegrino S, Polloni C, Ughi C, Zuin G, Fasano A, Catassi C |title=Introduction of gluten, HLA status, and the risk of celiac disease in children |journal=The New England Journal of Medicine |volume=371 |issue=14 |pages=1295–303 |date=October 2014 |pmid=25271602 |doi=10.1056/NEJMoa1400697 |type=comparative study |author-link18=Alessio Fasano |hdl=2318/155238 |doi-access=free |hdl-access=free }}</ref>