A physical approach to coeliac disease.

The morphological changes used to confirm a diagnosis of coeliac disease (CD) are precisely those predicted if the surface energy of the interface between duodenal epithelium and the luminal contents were raised to levels comparable to those demonstrated by the hydrophobic nature of the stomach wall. This hypothesis pursues the concept that, in coeliac patients, the gastric mucosal barrier (GMB) is effectively extended from the stomach to coat the duodenum, thus closing the window of absorption in the Gl tract. If studies are correct which indicate that the GMB is a physical reality provided by an adsorbed monolayer of surface-active phospholipid (surfactant) which renders surfaces hydrophobic, then it could also act as a barrier to the absorption of nutrients in the duodenum. Gluten, or its more active polypeptide fragment gliadin, exacerbates the situation in CD by acting as very effective carriers for the insoluble phospholipid which is deposited at the duodenal surface where they are digested by brush-border and pancreatic enzymes.