Celiac Disease Treatment & Follow-Up

OVERVIEW:

Celiac disease affects the digestive tract and is one of the major malabsorption disorders. It reduces the body's ability to absorb minerals, vitamins, carbohydrates, proteins and fats.

A common presentation is long-standing diarrhea. People may also become low in fat-soluble vitamins such as A, D, E and K. The disease is driven by an immune response to gluten in people with a genetic tendency.

There is no cure for celiac disease yet. Treatment controls it with a strict gluten-free diet, which for most people relieves symptoms and lets the intestine heal.

Experts estimate that about 2 million Americans have celiac disease, and many of them are undiagnosed, according to the NIDDK. Treatment is lifelong, and strict adherence is needed to keep symptoms under control.

WHAT IS CELIAC DISEASE?

Celiac disease is a digestive disease caused by an abnormal immune reaction to gluten. Gluten is found in wheat, barley, rye and many processed foods made from them.

Gluten can also hide in some medicines, supplements, lip products and toothpaste. In people with celiac disease, gluten triggers an immune attack on the small intestine that leads to the symptoms of celiac disease.

Celiac disease is also called gluten-sensitive enteropathy or celiac sprue.

Treatment for the Celiac Disease

There is no cure for celiac disease. A gluten-free diet is the main treatment, and medicines are used only in specific situations.

Treatment is lifelong. Strict adherence keeps symptoms under control and prevents complications.

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

Celiac disease management requires a lifelong gluten-free diet. This means avoiding wheat (including spelt, durum and semolina), barley, rye and triticale.

Rice, corn and potatoes are naturally gluten free and safe to eat. Research suggests most people with celiac disease can eat moderate amounts of oats labeled gluten free, but check with your doctor or dietitian first, per the NIDDK diet guide.

Regular dietary counseling helps. The most common reason people don't improve is accidental or hidden gluten in their diet.

2- Vitamins And Minerals Supplements For Celiac Disease Treatment:

Untreated celiac disease can cause malnutrition. Doctors may test for low vitamin and mineral levels and prescribe supplements when they are needed.

Talk with your doctor before taking any supplement. Supplements can also contain hidden gluten.

3- Micronutrients Supplements for the Treatment of Disease:

People with celiac disease are often low in iron, folate, vitamin B12, calcium, vitamin D and zinc. Doctors correct these deficiencies based on blood tests, usually without waiting for the intestine to heal.

Many people notice their symptoms improve within days to weeks on a gluten-free diet. Intestinal healing usually takes 3 to 6 months in children and can take longer in adults.

A bone density test may also be recommended to check for osteoporosis.

4- Corticosteroids:

Rarely, symptoms and intestinal damage continue despite a strict gluten-free diet. This is called refractory celiac disease.

In these cases, doctors may use corticosteroids such as prednisone to reduce inflammation and help the intestine heal. Steroids are usually used short term because of their side effects.

5- Immunosuppressant, For Disease Treatment:

A small number of people with refractory celiac disease may need other medicines that calm the immune system. These treatments are managed by specialists.

These immunosuppressive drugs work by suppressing the overactive immune response. They can help control the disease and prevent complications in people who don't respond to diet alone.

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

Regular follow-up is key to celiac disease treatment. At each visit, your doctor checks your symptoms and nutritional status and may order blood tests.

Antibody levels, such as anti-tissue transglutaminase (tTG) and anti-endomysial antibodies, are usually high before treatment and return to normal on a gluten-free diet.

Repeat small bowel biopsies are not always needed. They are considered mainly when symptoms continue despite a gluten-free diet. If symptoms persist, a dietitian and a food journal can help find hidden gluten or other causes, such as irritable bowel syndrome or lactose intolerance.

Why Patient Education Is Necessary?

Patient education plays a vital role in celiac disease treatment. The main cause of treatment failure is accidental or unrecognized gluten in the diet.

People need to learn which foods are safe and which are not, how to read labels, and where gluten hides. In the US, foods labeled gluten free must contain less than 20 parts per million of gluten.

For this purpose, it is best to see a registered 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

HP Thoughts: Aside from proper celiac disease medication, you should be equipped with sufficient information regarding food intake: Celiac Disease Food to Avoid.