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  1. The global burden of coeliac disease: opportunities and challenges
    Makharia GK, Singh P, Catassi C, Sanders DS, Leffler D, Ali RAR, et al.
    Nat Rev Gastroenterol Hepatol, 2022 Jan 03.
    PMID: 34980921 DOI: 10.1038/s41575-021-00552-z
    Coeliac disease is a systemic disorder characterized by immune-mediated enteropathy, which is caused by gluten ingestion in genetically susceptible individuals. The clinical presentation of coeliac disease is highly variable and ranges from malabsorption through solely extra-intestinal manifestations to asymptomatic. As a result, the majority of patients with coeliac disease remain undiagnosed, misdiagnosed or experience a substantial delay in diagnosis. Coeliac disease is diagnosed by a combination of serological findings of disease-related antibodies and histological evidence of villous abnormalities in duodenal biopsy samples. However, variability in histological grading and in the diagnostic performance of some commercially available serological tests remains unacceptably high and confirmatory assays are not readily available in many parts of the world. Currently, the only effective treatment for coeliac disease is a lifelong, strict, gluten-free diet. However, many barriers impede patients' adherence to this diet, including lack of widespread availability, high cost, cross-contamination and its overall restrictive nature. Routine follow-up is necessary to ensure adherence to a gluten-free diet but considerable variation is evident in follow-up protocols and the optimal disease management strategy is not clear. However, these challenges in the diagnosis and management of coeliac disease suggest opportunities for future research.
  2. World Gastroenterology Organisation Global Guidelines: Diet and the Gut
    Makharia G, Gibson PR, Bai JC, Karakan T, Lee YY, Collins L, et al.
    J Clin Gastroenterol, 2022 Jan 01;56(1):1-15.
    PMID: 34860201 DOI: 10.1097/MCG.0000000000001588
  3. Celiac disease care differs significantly between high- and low-middle-income countries: a global survey of celiac experts from 63 countries
    Agarwal S, Prasad S, Agarwal A, Raja Ali RA, Leffler DA, Green PHR, et al.
    J Gastroenterol Hepatol, 2024 Nov 11.
    PMID: 39528309 DOI: 10.1111/jgh.16793
    BACKGROUND AND AIM: Celiac disease (CeD) is increasingly diagnosed but significant disparities exist in awareness, practices, resources, and legislation worldwide. We conducted a global online survey with CeD experts to assess this disparity internationally.

    METHODS: A 55 questions survey encompassing nine domains relevant to CeD care (awareness, gluten-free [GF] foods availability/cost/quality, GF labeling, CeD dietician availability, insurance for CeD patients, medical training, research funding, patient support groups, and unmet needs) was generated and sent to CeD experts worldwide electronically. Countries were stratified based on per capita income as high-income (HIC) and lower-income countries (LIC) (including upper-middle-, lower-middle-, and low-income countries). Survey responses were summarized as a single score using principal component analysis.

    RESULTS: Valid responses were obtained from 131(37.4%) [HIC: 71; LIC: 60] of contacted CeD experts from 63 countries. Compared with HIC, LIC experts perceived worse availability (HIC:80% vs LIC: 47%; P 

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