The Gut Microbiota and Probiotics in Celiac Disease

Celiac disease (CD) is an immune-mediated enteropathy that occurs in genetically predisposed individuals associated with gluten intake. Currently, the only effective treatment for CD is life-lasting elimination of gluten from the diet, but adhering to it throughout life is burdensome. In addition, strict compliance with a gluten-free diet (GFD) does not lead to a complete restoration of intestinal microbiota. Although gluten is known to be a trigger in CD, various studies have demonstrated that the gut microbiota is involved in gluten metabolism, regulation of intestinal barrier permeability, and modulation of the immune response. Therefore, the gut microbiota has an important role in the pathogenesis, progression, and clinical manifestations of CD. This evidence supports the hypothesis that probiotics act as a strategy to modulate the intestinal microbiota into an anti-inflammatory state. Probiotics such as some bacterial species of the genera Bifidobacterium and Lactobacillus can protect the epithelial cells from gliadin-induced damage and improve symptoms and quality of life in GFD-treated patients, as an adjunctive treatment. This narrative review aims to discuss the recent scientific evidence of the relationship between the intestinal microbiota changes in CD and to understand the role of probiotics in CD treatment.