Celiac Disease:
Research, Clinical Expertise, and Multidisciplinary Care at the UChicago Medicine Digestive Diseases Center
By: Anna Gomberg
Celiac disease, a debilitating autoimmune digestive disease, is a high priority for clinicians and researchers at the University of Chicago Medicine. Celiac disease affects 1 in 100 people, has no cure, can develop at virtually any point across the lifespan, and has known hereditary links. In a time when eating gluten-free is increasingly popular, for patients with celiac disease, it is imperative, as damage to the small intestine due to the body’s immune response can lead to serious health problems and complications, as well as pain and discomfort. Without treatment, celiac disease can lead to other disorders and diseases, like Type I diabetes, anemia, malnutrition, infertility, and increased risk for intestinal cancer, among others. Early diagnosis decreases these risks across the lifespan.
Much remains unknown about celiac disease. Earlier this year, Bana Jabri, MD, PhD, led research efforts resulting in the first mouse model of celiac disease. With collaborators at the University of Chicago Medicine Digestive Diseases Center, including Valerie Abadie, PhD, Luis Barreiro, PhD, and many others, this research was published in the preeminent scientific journal, Nature, and heralded as an essential breakthrough for the scientific understanding of celiac disease. The mice developed for this model manifest celiac disease in much the same way as humans, specifically with regard to the overproduction of interlukin-15 (IL-15), a protein principally made by white blood cells that affects immune responses. Jabri and collaborators’ earlier landmark work, in Science in 2017, identified a potential viral trigger that could lead to greater understanding of the cause of celiac disease.
New research, currently in the very beginning stages, is examining the connection between neurological symptoms like “brain fog” and celiac disease. Research conducted at the University of Chicago Medicine Digestive Diseases Center is looking at the mechanisms through which celiac and other gluten disorders could contribute to these symptoms, including the microbiome, structural, and cellular differences that could explain why they occur.
Working in tandem with these basic and translational scientists, the clinical research and treatment of celiac disease is at the forefront of digestive diseases care.
“Our research can serve patients in different ways. For one, we want to give credibility to people who say they have these debilitating symptoms, through the use of radiology [MRI and other diagnostic techniques]. The angle that we need to think about is, ‘Why? Why is this happening?’ This will help us understand the complexities of celiac disease, and care for the patient.” explains Ritu Verma, MD, Chief of Pediatric Gastroenterology at the University of Chicago Medicine.
For pediatric patients, celiac disease means adjusting to a restricted diet, health maintenance regimens, as well as coordination and education of parents and caregivers. Under the leadership of Ritu Verma, MD, pediatric celiac patients are seen in a new multidisciplinary clinical setting, even in the video telehealth visits necessitated by COVID-19. Patients and their families are seen by a registered dietitian and a pediatric gastroenterologist together, at the same time. The input of a dietitian is vitally important, as the only known treatment for celiac disease is a strict gluten-free diet. For patients with co-occurring endocrine conditions (Type I diabetes, for example), an endocrinologist consults as well.
“This helps patients to look upon GI and nutrition as a team, and we need both team members to provide the best care,” explains Verma, “If a patient is seeing the gastroenterologist, having their labs done, and that’s it, we are missing vital components of their care.” Also critical is attending to the social and emotional well-being of the patient, and patient referral to a psychologist who specializes in chronic GI illnesses is a key part of Dr. Verma’s comprehensive approach to treating celiac disease.
Dr. Verma and colleagues, including Carol Semrad, MD, Professor of Medicine and adult gastroenterologist specializing in small bowel disease and celiac disease, are looking at ways to improve the use of diagnostic tools available in the surveillance of celiac disease. One such tool, capsule endoscopy, may be effective as a tool assessing celiac disease without the need for anesthetic or sedation, which would be especially welcome during the COVID-19 pandemic.
What does the future hold, in terms of a cure for celiac disease? According to Dr. Verma, it depends on what you mean by cure.
“I always ask people, ‘What do you think is a cure for celiac?’ It’s a very different mindset for pediatric patients and for adults. If a cure is that a person will be able to eat a regular gluten-containing diet, then it is quite far away. But for children with celiac and their parents, life would be made much easier if they could eat out or at home without constant worries about cross contamination on kitchen surfaces, cooktops, and other equipment. They don’t want to ask those questions, questions like, ‘are the French fries fried in the same fryer as chicken nuggets?’ A medical treatment that could offer this protection would be life-changing,” she explains.