Genetic and immunological processes in the pathomechanism of gluten-sensitive enteropathy and associated metabolic bone disorders

Celiac disease, or gluten sensitive enteropathy is a relatively common disease of the jejunum, leading to malabsorption. It is an immune mediated disease, induced by gluten on the grounds of a specific genetic makeup. After gluten exposition immune processes are induced mainly by T-cells, causing typical intestinal and extra intestinal manifestations. The diagnosis of celiac disease is based on jejunal biopsy histology and the presence of antibodies against endomysium and tissue transglutaminase. Genetically, celiac disease is associated with HLA DQ2/DQ8. Strict gluten-free diet improves the clinical, histological and serological picture and remission may be achieved. In the etiopathogenesis of celiac disease several genetic and immunological mechanisms have been recognized in the recent years. Concerning accompanying diseases/extraintestinal manifestations, several disorders have been shown, including rheumatological diseases. In celiac disease, bone metabolic changes are more frequent compared to the prevalence of inflammatory join disorders. In this review, we aim to give an overview on various aspects of the genetic and immunological processes in the pathomechanism of gluten-sensitive enteropathy and associated metabolic bone disorders.