Background: Coeliac disease (CD) is an immune-mediated condition triggered by gluten exposure in genetically susceptible individuals. Increasing evidence suggests that alterations in gut microbial communities contribute to disease development by disrupting the gut–brain–immune axis. Bidirectional communication between gut microbes, the immune system, and the central nervous system may underlie both gastrointestinal and neurological features of CD [1,2].
Objective: To examine the role of the gut microbiome in modulating gut–brain–immune interactions in CD, and to evaluate the therapeutic potential of targeted probiotic interventions in supporting microbial balance and clinical outcomes.
Methods: This review draws on randomized controlled trials, mechanistic studies, and systematic analyses investigating microbial alterations in CD. It focuses on microbial influences on immune regulation, intestinal permeability, and neuroimmune signalling pathways.
Results: Findings from the literature will be discussed, highlighting evidence of gut microbial imbalance in CD, including reduced beneficial bacterial populations and altered microbial diversity compared with healthy individuals [1,3]. The role of beneficial microbes in modulating immune responses will be explored, particularly effects on pro-inflammatory cytokines such as TNF-α and short-chain fatty acid production [4,5]. Evidence from double-blind RCTs of targeted probiotic interventions in newly diagnosed paediatric CD will be reviewed, focusing on reported improvements in disease markers and microbial restoration [2]. Mechanistic pathways will be discussed, including enhancement of intestinal barrier integrity, regulation of immune activity, and modulation of gut–brain communication via vagal signalling [6]. A case study will also be presented to illustrate clinical presentation and response to probiotic support alongside a gluten-free diet.
Conclusion: The gut microbiome plays an important role in maintaining gut–brain–immune balance in CD. Targeted probiotic strategies may represent a promising adjunct to standard dietary management, with potential to support symptom improvement and microbial restoration.