Difficulties encountered when treating coeliac disease : from molecule to miracle cure?

Dietary treatment of coeliac disease should be based on a sound theoretical knowledge of the different immunogenicities of various cereal grains, an appreciation of the limitations of the current Codex Alimentarius recommendations and an understanding of the factors that limit dietary compliance in many patients. The expertise of dieticians, nutritional chemists, gastroenterologists and clinical pharmacists should be made readily available to coeliac patients, to coeliac societies and to coeliac self-help groups. Various enzymatic and pharmacological modalities that may be used to treat coeliac disease in the future are highlighted as potential ways to improve quality of life in these patients in whom the coeliac diet often promotes poor compliance or may lead to significant social alienation.peer-reviewe