Celiac disease historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Since the advent of human life on the earth, human beings have met their nutritional demands through hunting. In times of scarce supply of food from animal sources humans used to turn to fruits, seeds, and nuts for their nutritional needs. About 8,000 years ago, Aretaeus, a Greek physician from Cappadocia, wrote a total of 8 books on medicine. In one of his books, he described a patient with celiac disease and called it 'koiliakos'. It came from Greek word of 'koelia' (abdomen), explaining diarrhea as the inability to retain food and the passage of undigested material through the gastrointestinal tract. This later formed the basis of explanation of various diseases presenting as chronic malabsorptive diarrhea, including celiac disease. In October 1887, Samuel Gee, an English pediatrician, comprehensively explained celiac disease in one of his lectures. Gee was of the opinion that if a patient affected by celiac disease can be cured at all, it must be by means of diet. He also added that the percentage of farinaceous food intake in celiac patients must be low. Gee also introduced the concept of gluten-free diet for the relief of symptoms.

Historical Perspective

Here is the historical perspective of celiac disease at a glance

Beginning of the human beings

2.5 million years ago

Hunting and eating meat, fruits, seeds, and nuts

10,000 years ago

Neolithic period

Discovery of agriculture. New antigens have produced to human beings daily regimen (milk from cow, goat, and donkey proteins, bird eggs, and various cereals). First cases of celiac disease.

Discovery

2,000 years ago

Aretaeus Cappadocian, a Greek physician

Described celiac disease, calling it koiliakos. It came from Greek word 'koelia (abdomen), representing a "suffering abdomen"

1812

Mathew Baillie A Scottish physician

Described some adult patients experiencing malnutrition and bloating along with chronic diarrhea

1887

Samuel Gee A famous English pediatrician

Gave a detailed explanation of celiac disease, presenting a lecture on "Celiac affection"

1924

Sidney Haas New York city pediatrician

Used a new dietetic therapeutic option for 10 children with celiac disease, the banana diet

1949

Wood Australian gastroenterologist

Invented a simple flexible biopsy tube which could be used for GI biopsies without requiring X-ray or gastroscope assistance

1950

Wim Dicke Dutch pediatrician

Suggested in his doctoral thesis that elimination of wheat, rye, and oats from diet would result in cure of celiac disease

1950

Wim Dicke's colleagues, Weijers and Van de Kamer

Presented stool fat measurement as a method to diagnose celiac disease

1954

John Paulley English pathologist from Ipswich

Discovered the pathophysiology of celiac disease, the histological abnormalities in small intestine lining

Diagnosis

1955

Marcelo Royer Argentinian gastroenterologist from Buenos Aires

Developed a reliable technique for duodenal biopsy under fluoroscopic vision

1956

Margot Shiner German-British gastroenterologist

Developed a reliable technique for duodenal biopsy under fluoroscopic vision

1964

Berger Switzerland immunologist

Detected and reported anti gliadin antibodies in children with celiac disease

1969

European Society of Pediatric Gastroenterology (now ESPGHAN)

Gave the diagnostic tool of “Interlaken criteria”, which was used for about 20 years

1971

Seah A British physician

Discovered an auto-antibody, the anti-reticulin antibody; showing that antibody is not necessarily an anti-food protein

1983

Chorzelski A Polish dermatologist from Warsaw

Discovered anti-endomysium antibodies and dermatitis herpetiformis in celiac disease patients

Treatment

Recently

Main guidelines

• Agency for Healthcare Research and Quality (AHRQ, 2004) • American Gastroenterological Association (AGA, 2006) • North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NSPGHAN, 2005) • European Society of Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN, 2012) • National Institute for Health and Clinical Excellence (NICE, 2015)

Discovery

• At the beginning of human life on the earth, nutritional demands were met through hunting. In severe circumstances, inability to hunt for a while, encouraged the utilization of fruits, seeds, and nuts.
• From 10,000 years ago the mankind learnt to cultivate and grow agriculture. He has been able to produce foods that have not been produced for 2.5 million years.
• During Neolithic period, some new foods such as milk from cow, goat, and donkey, along bird eggs, and also various cereals were introduced for daily utilization of human beings.
• Among the products of agriculture, wheat showing a good rate of multiplication and also good resistance to harvesting, became the main food source of agriculture mankind.
• There were no problems with the new regimen for a long time, till some members of the tribe faced with new problems, after eating wheat.
• About 2,000 years ago, Aretaeus, a clever Greek physician from Cappadocia, has written total of 8 books about different topics of medicine. In one of his books, he completely described a patient with celiac disease, called it 'koiliakos'. It came from Greek word of 'koelia' (abdomen), represent as “if the stomach be irretentive of the food and if it pass through undigested and crude, and nothing ascends into the body, we call such persons coeliacs”.
• 17 centuries later, in early 19th century, Mathew Baillie, an Scottish physician, probably unaware of Aretaeus, presented his point of view about some adult patients experiencing malnutrition and bloating abdomen along with chronic diarrhea due to specific regimen, “some patients have appeared to derive considerable advantage from living almost entirely upon rice". Unfortunately, his work was not considered so much.
• In October 1887, Samuel Gee, an English leading authority in pediatrics, has gained the full credit of explanation of celiac disease, presenting "celiac affection" lecture to medical students; which is published next year. Gee mentioned that "If the patient can be cured at all, it must be by means of diet". He also added that "the allowance of farinaceous food must be small". He also found the gluten-free diet as a relief, the symptoms relapse when gluten introduced again.
• In 1920s, Sidney Haas, a New York city pediatrician, used a new dietetic therapeutic option for 10 children with celiac disease, the banana diet; regarding his previous successful experience in treating a child with anorexia nervosa by the regimen. He presented the results as 8 of them "clinically cured" and remained 2 died.
• In 1949, Wood, an Australian gastroenterologist, invented a simple flexible biopsy tube which can be used for GI biopsies without need to X-ray or gastroscope.
• In 1950, Wim Dicke, a Dutch pediatrician, suggested in his doctoral thesis that elimination of wheat, rye, and oats from diet would be result in reasonable cure. He found that the pathological factor is gluten, indeed.
• At the same time, Wim Dicke's colleagues, Weijers and Van de Kamer, presented a way to diagnosis of the celiac disease, stool fat measurement.
• In 1954, John Paulley, a pathologist from Ipswich in England, discovered the histological abnormalities in small intestine lining as the main pathophysiology of celiac disease.

Diagnosis

• In 1955, Marcelo Royer, a gastroenterologist from Buenos Aires, developed a reliable technique for duodenal biopsy under fluoroscopic vision. He was inspired by Wood's instrument in this way.
• In 1956, Margot Shiner, a German-British gastroenterologist, also developed a reliable technique for duodenal biopsy under fluoroscopic vision. He was inspired by Wood's instrument in this way.
• In 1986, the Coeliac society on United Kingdom was founded. Similar societies also became founded around the world.
• In the mid to late 60’s, the main route of diagnosing the celiac disease was assumed as jejunal biopsy, showing villus atrophy. But regarding that the atrophy of villi may have some other causes, the diagnosis could not be approved until it is found that the cause of atrophy is gluten.
• In 1964, Berger, a Switzerland immunologist, detected and reported anti gliadin antibodies in celiac children.
• In 1969, European Society of Pediatric Gastroenterology (today ESPGHAN), present the diagnostic tool of “Interlaken criteria”, which was used for about 20 years. The criteria composed of full remission of the symptoms upon being on gluten-free diet, along with curing the atrophic lesions in GI lumen, and finally recurrence of the disease once the gluten start again.
• In 1971, Seah, a British doctor, found that the antibody is not necessarily an anti-food protein, but it is actually an auto-antibody, the anti-reticulin.
• In 1983, Chorzelski, a dermatologist from Warsaw, discovered anti-endomysium antibodies in celiac disease and dermatitis herpetiformis.

Treatment

• The main management guidelines are issued by Agency for Healthcare Research and Quality (AHRQ, 2004), the American Gastroenterological Association (AGA, 2006), the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NSPGHAN, 2005), the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN, 2012)
  National Institute for Health and Clinical Excellence (NICE, 2015).

Outbreaks

• There have been just one outbreak of celiac disease in Sweden, which is summarized below:
  • Regarding that the celiac disease has some genetic, immune mediated and chronic features, rarely can contributed to an outbreak.
  • This is quite unique for celiac disease, suggests some evolution in causal factors or environment in Swedish children population.
  • It is assumed that every outbreaks can be caused by introducing large amounts of gluten contained foods to children, right after breast milk.
  • By the beginning of outbreak the rise in girls was more than boys.
  • Children that were born in summer have higher rate of celiac disease, probably due to high gluten foods during the winter, when the infections are more common.

Landmark Events in the Development of Treatment Strategies

• In October 1887, Samuel Gee, an English leading authority in pediatrics, has gain the full credit of explanation of celiac disease, presenting "celiac affection" lecture to medical students; which is published next year. Gee mentioned that "If the patient can be cured at all, it must be by means of diet". He also added that "the allowance of farinaceous food must be small". He also found the gluten-free diet as a relief, the symptoms relapse when gluten introduced again.

Famous Cases

• The following are a few famous cases of celiac disease:
  • Drew Brees: Star quarterback for the Saints
  • Justin Morneau: Twins first baseman Justin Morneau
  • Chelsea Clinton: Bill Clinton’s daughter
  • Zooey Deschanel: Star of the show “New Girl”
  • Novak Djokovic: World renowned tennis player
  • Victoria Beckham: Wife of soccer star, David Beckham
  • Jessica Simpson: Actress
  • Amy Yoder Begley: Olympic runner
  • Ryan Phillippe: MacGruber star
  • Susie Essman: Mostly known for her role on the show “Curb Your Enthusiasm”
  • Rachel Weisz: Appeared in films such as “Constantine” and “The Mummy”
  • Heidi Collins: A news anchor for CNN
  • Robin McGraw: Dr. Phil’s wife
  • Keith Olbermann: A broadcaster for Fox and ESPN
  • Cedric Benson: Cincinnati Bengals running back
  • Josh Turner: Famed country singer
  • Elisabeth Hasselbeck: Member of “The View”
  • Emmy Rossum: Known for her glamorous acting
  • Dana Vollmer: U.S. swimmer
  • James Starks: Green Bay Packers running back