The cornerstone of treatment of coeliac disease is a gluten-free diet devoid of proteins fromwheat,
rye, barley and related cereals. Oats are tolerated by most patients with coeliac disease but are not
totally innocent. There are considerable differences between individual patients with respect to
clinical and mucosal responses to gluten challenge. In vitro and in vivo testing has identified
synthetic peptides that are toxic to the coeliac small intestinal mucosa. This toxicity overlaps at
least partly to the known epitopes that are recognised by small intestinal T-cells. However, the
clinical significance of several of these epitopes is unclear, as is the maximum level of gluten intake
that can be recommended to be safe for patients with coeliac disease. Future efforts may lead to
better understanding of the disease processes as well as possible new therapeutic options.