Novel complementary strategies for the management of consistent gastrointestinal symptoms of Celiac disease.

Celiac disease (CD) is a chronic autoimmune disorder of the small intestine triggered by gluten consumption in genetically predisposed individuals. While a strict lifelong gluten-free diet (GFD) is the primary management strategy, adherence to GFD is challenging due to the ubiquity of gluten, risks of cross-contamination, and inferior nutrition. Additionally, many patients experience persistent gastrointestinal (GI) symptoms despite strict GFD compliance. Functional foods and nutraceuticals, known for their health benefits beyond basic nutrition, have shown potential in alleviating CD-related issues such as GI symptoms, gut dysbiosis, intestinal inflammation, gut barrier dysfunction, and associated nutritional deficits. This review explores the role of functional foods and nutraceuticals, including low FODMAP diets, anti-inflammatory diets, non-gluten cereals and pseudocereals, gluten sequestrants, probiotics, prebiotics, synbiotics, postbiotics, as well as digestive enzymes, transglutaminase 2 inhibitors, modified gluten products, and other emerging agents, as complementary strategies to enhance GFD efficacy and prevent or ameliorate persistent GI symptoms in CD patients. By synthesizing evidence from preclinical and clinical studies, the mechanisms and therapeutic potential of these interventions in addressing persistent symptoms in CD and related gluten disorders are discussed.