El gluten. Su historia y efectos en la enfermedad celíaca
The massive use of endomysial and anti transglutaminase antibodies has led to describe a new epidemiology of celiac disease, mainly because it incorporates the atypical presentations of this condition. The estimated average global prevalence of celiac is one per 250 inhabitants. The disease is induced by gluten, a peptide contained in wheat, rye and barley that during small intestinal digestion generates smaller peptides, some of which are quite resistant to hydrolysis; they go through the epithelium into the mucosa and induce a cascade of immune reactions leading to the appearance of the disease in susceptible individuals. Gluten appeared as a consequence of agricultural practices initiated 10000 years ago in the Fertile Crescent in south East Asia. Consumption of gluten differs depending on the origin of population groups, which represent an additional difficulty when analyzing the condition’s epidemiology. Treatment of celiac disease consists of withdrawing gluten from the diet, a difficult task to maintain in the long term; defining what a gluten-free food is has changed along time. This article updates the concept of celiac disease, the history of gluten consumption in the world and the characteristics of gluten free diet and the difficulties to adhere to it.