Celiac Disease Treatment & Follow-Up

OVERVIEW:

Celiac disease involves the gastrointestinal tract and is one of the major malabsorptive syndromes. The Hallmark of celiac disease and all other malabsorptive syndromes are defective absorption of minerals, vitamins, carbohydrates, proteins, and fats. The main clinical presentation is long standing diarrhea. There is an inability to absorb water soluble and fat soluble vitamins like vitamin A, vitamin D, vitamin E and Vitamin K. It is characterized by humoral and cell mediated immune responses against gluten in genetically susceptible individuals.

Celiac disease treatment is not yet known as there is no proper cure for celiac disease. Disease treatment involves only symptomatic control of the disease. According to a recent study celiac disease is increasing day by day and 1 out of 150 Americans is suffering from celiac disease. Celiac disease treatment has a lifelong course and strict compliance is required to cure the symptoms.

WHAT IS CELIAC DISEASE?

Celiac disease is a digestive tract disease and is caused by abnormal immune reactions going on inside the body. It is due to the intake of the gluten component of the diet which is present in oats, wheat, Barley, rye, and other processed grains. Gluten is now also a component of various medications, drugs, seasonal food items, and lipstick. Gluten sensitivity means the body is not able to break the gluten component of the diet and it results in symptoms of celiac disease which causes celiac disease treatment difficult. Celiac disease is also called as due to gluten sensitive enteropathy and sprue.

Treatment for the Celiac Disease

the disease treatment up till now has not been discovered. There is no cure for celiac disease and only medications and gluten free diet is given to the patient for symptomatic control and to decrease the exacerbations of the disease. The disease treatment has a long-term course and strict compliance is required for control of symptoms.

1- Gluten Free Diet, Mainstay of Celiac Disease Management:

Celiac disease management requires a lifelong gluten free diet. Dietary follow-up is key for the management of the celiac disease. Gluten free diet requires exclusion of rice, wheat, Barley, and initially oats. Although oats can be introduced in most patients after 6 to 12 months of Celiac disease treatment. Frequent dietary counseling is required to the patient for celiac disease management and to ensure that proper gluten free diet is being observed by the patient as the most common reason for failure to improve for the patient of the disease is noncompliant patients for gluten free diet.

2- Vitamins And Minerals Supplements For Celiac Disease Treatment:

Vitamins and minerals implementations are given to patients when they are indicated. These are not usually necessary when a patient adherence to gluten free diet strictly but many studies show that vitamin and mineral supplementation is required in celiac disease treatment as there is Malabsorption of various nutrients and it reduces the normal amount of important minerals and vitamins in the body.

3- Micronutrients Supplements for the Treatment of Disease:

The disease treatment requires correction of coexisting deficiencies of various micronutrients like calcium, magnesium, vitamin D, iron, Folic acid, zinc, riboflavin, albumin, and proteins. Initially, these micronutrients are not given for 6 to 12 months of gluten free diet so as to allow the intestinal mucosa to heal. If they are given in initial stages of celiac disease treatment, it will cause impairment of intestinal mucosa healing as it will cause a burden on the intestine. They can be added to the diet after 1 year of initiation of the treatment as the small intestine mucosa starts to heal after 1 year of celiac disease treatment.

4- Corticosteroids:

When the patients fail to respond to gluten free diet it is called treatment failure. the disease Treatment failure remains in a small number of patients who fail to respond to the diet and they require therapy with corticosteroids. Corticosteroids will reduce the inflammatory process going on inside the body and allow the Small intestinal mucosa to heal. Corticosteroids are given for short term uses only as the harmful effects are more than the benefits of Steroids in long term usage.

5- Immunosuppressant, For Disease Treatment:

The small number of patients do not respond to gluten free diet and they remain symptomatic and celiac disease treatment is rendered ineffective in such cases. They require therapy with immunosuppressive drugs. The immunosuppressive drugs have a mechanism of action to suppress the immune system which is highly sensitive in celiac disease. When the immune system is rendered ineffective the chances of exacerbations of celiac disease are reduced and helps in celiac disease management and preventing complications.

6- Dietary Follow Up, Key for Celiac Disease Management:

The strict diet follows up is the key to celiac disease treatment. Patients should be taught to follow up after initiation of gluten free diet and in every follow-up, there should be the assessment of patient symptoms, his nutritional status, and the blood samples should be taken for measurement of anti endomysial antibody and anti-tissue transglutaminase antibody.

Frequent small bowel biopsies are not usually required on routine follow for celiac disease treatment and it should only be considered in patients who remain symptomatic even in the presence of gluten free diet. Gluten free diet remains satisfactory disease treatment but if other complications like pancreatic insufficiency for colitis are seen in patients then the associated condition should also be treated along with celiac disease treatment.

Why Patient Education Is Necessary?

Patient education plays a vital role in celiac disease treatment. The patient should be educated about the disease and the importance of a gluten free diet for the treat celiac disease treatment. The main cause of celiac disease management failure is accidental or unrecognized ingestion of gluten and this leads to the exacerbations of symptoms and celiac disease treatment failure. He should be taught about the foods which he can eat and foods that he cannot eat for the disease treatment. For this purpose, it is best to refer them to a dietitian who will

  • set his diet
  • design his meals
  • educate him about which foods he should take
  • tells about which food are not to be eaten
  • check the food concentration of gluten
  • give healthy food advice