Celiac Disease: Current and Investigational Therapies and the Role of the Pharmacist

Celiac disease is a genetically-linked autoimmune disease which affects the gastrointestinal tract. It is an inflammatory reaction to ingested gluten-containing substances that produces the most frequent symptoms of abdominal pain, bloating and intermittent or chronic diarrhea. Diagnosis can be made by blood testing for specific IgA autoantibodies and a confirmation duodenal biopsy to look for the characteristic scalloping and villous atrophy that occurs in response to the inflammation. A gluten-free diet, until recently, was the only treatment available and continues to be the mainstay of treatment. Newer adjunct therapies to dietary management include larazotide acetate, peptidases, the use of parasite Necator americanus, a desensitizing vaccine, polymeric binders, cytokine antagonists, tissue transglutaminase inhibitors, probiotics and anti-inflammatory therapy. This review will outline the potential of each of these therapies and discuss the role of the pharmacist in assisting patients with Celiac disease