Coeliac disease involves immune-mediated damage to the small intestine after gluten exposure in genetically susceptible individuals, with increased intestinal permeability recognized as a central pathophysiological feature. The literature summarized describes mechanisms that may disrupt barrier integrity, including the role of zonulin, proinflammatory cytokines, microbial alterations, and gliadin peptide–driven immune responses.
Evidence for permeability changes is discussed in the context of disease activity and remission, though the strength and consistency of data across studies are not detailed here. Therapies aiming to restore barrier function are reviewed, encompassing dietary modifications and supplements, as well as experimental and investigational pharmacologic agents such as larazotide acetate and IMU-856.
The article also emphasizes the need for reliable biomarkers to quantify intestinal permeability in coeliac disease and calls for continued research into barrier-normalising strategies as a means to sustain remission. Where data are incomplete or uncertain in the reviewed sources, this ambiguity is acknowledged.
No specific clinical outcomes or comparative effectiveness data are provided in the summary presented.
Gut (BMJ) published a clinical update in Research Highlights on 06 Mar 2026.
The item focuses on Coeliac disease and the intestinal barrier: mechanisms of disruption and strategies for restoration.
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