Although there’s no cure, symptoms can be effectively controlled through dietary changes to avoid all foods with gluten. However, if you think you might have celiac disease, don’t start a gluten-free diet until you’ve been tested for the condition, since eliminating gluten can cause misleading test results, cautions Dr. Tennyson.
Because the disease can also spark vitamin and mineral deficiencies, patients may also need supplements. For people with severe small intestine inflammation, doctors sometimes prescribe steroids.
The standard treatment of disease patients calls for complete avoidance of gluten for life. The principles of a gluten free diet include:
Avoid all foods made from wheat, rye, and barley. Examples are breads, cereals, pasta, crackers, cakes, pies, cookies, and gravies.
Avoid oats. Some patients with celiac disease can tolerate oats in the diet. But long-term safety of oats in celiac disease patients is unknown. Also some oat preparations can be contaminated with wheat. Thus, it is probably best to avoid oats at least during the initial treatment with a gluten free diet. Once disease remission is achieved with a strict gluten free diet, small quantities of oats can be reintroduced into the diet under medical supervision.
Pay attention to processed foods that may contain gluten. Wheat flour is a common ingredient in many processed foods. Examples of foods that may contain gluten, to name only a few, include:
Beware of tablets, capsules, and vitamin preparations that contain gluten. Wheat starch is commonly employed as a binding agent in tablets and capsules. Gluten also can be found in many vitamin products, and cosmetic products such as lipstick.
Avoid beer. It is all right to drink wine, brandy, whiskey and other non-wheat or barley alcohol (in moderation!)
Avoid milk and other dairy products that contain lactose. Untreated patients with celiac disease often are lactose intolerant. With successful treatment, dairy products can be reintroduced slowly into the diet later. It is alright to consume fish, fresh meats, rice, corn, soybean, potato, poultry, fruits, vegetables, and dairy products (for patients who are not lactose intolerant)
Consult dietitians and national celiac disease societies for lists of gluten free foods. Read the food and product labels before buying or consuming any product. This is necessary because a manufacturer may change a product's ingredients at any time. A product that was gluten-free in the past may now contain gluten. Even branded products may be gluten free in one country but contain gluten in another country. If one is not certain after reading the labels, call the manufacturer.
Because patients with severe malabsorption can develop vitamin and mineral deficiencies, vitamin and mineral supplements are important. All patients should take a multivitamin daily. Patients with iron deficiency anemia should be treated with iron. Patients with anemia due to folate or B12 deficiency should be treated with folic acid and B12. Patients with an abnormal ProTime should be treated with vitamin K. Patients with low blood calcium levels or with osteoporosis should be treated with calcium and vitamin D supplements.
In most patients, a gluten free diet will result in improvements in symptoms within weeks. Many patients report symptom improvements within 48 hours. In children with celiac disease, the response to a gluten free diet can be dramatic. Not only will diarrhea and abdominal discomfort subside, but behavior also improves, and growth resumes (with rapid catch up in height). These improvements in symptoms are followed by reappearance of intestinal villi. Complete normalization of the intestinal villi may take months. In many adult patients, the improvement in symptoms is followed by only partial regeneration of intestinal villi. In patients with dermatitis herpetiformis, the skin lesions also improve with a gluten free diet.
Many patients with celiac disease may not understand the importance of life-long adherence to a gluten free diet. A recent study found that among patients diagnosed at least 20 years earlier with celiac disease, only half of the patients were following a strict gluten-free diet. The primary reason that patients followed the diet was to prevent symptoms-not to prevent complications. There was evidence of mild iron deficiency and abnormal bone density each in one-third of the patients, suggesting that the lack of adherence to the diet was having health consequences.
What if patients fail to respond to gluten free diet?
Failure to respond to a gluten free diet can be due to several reasons:
What is refractory celiac disease?
Refractory celiac disease is a rare condition in which the symptoms of celiac disease (and the loss of villi) do not improve despite many months of a strict gluten free diet. Before making a diagnosis of refractory celiac disease it is important to exclude complications of celiac disease and other co-existing conditions that can produce similar symptoms. It is believed by many knowledgeable physicians that refractory celiac disease is a malignant condition, that is, it is a cancer.
What is the treatment for refractory celiac disease?
The treatment of refractory celiac disease is first to make sure that all gluten is eliminated from the diet. If there still is no improvement, medications are used. Corticosteroids such as prednisone have been used successfully in treating some patients with refractory celiac disease. Immuno-suppressive drugs (medications that suppress a person's immune system) such as azathioprine and cyclosporine also have been used. (These drugs also are used in treating some types of cancer.) Corticosteroids and immunosuppressive drugs are potent medications with potentially serious side effects. Many patients with refractory celiac disease are malnourished and have weakened immune systems, and corticosteroids and immunosuppressive agents can further increase their risk of serious infections. Thus doctors experienced with treating celiac disease should monitor treatment of refractory celiac disease.
Unfortunately in some patients with refractory celiac disease, malabsorption and malnutrition progress despite drugs. In these patients the intravenous route is the only way to deliver nutrition. Total parenteral nutrition (TPN) is a way of delivering calories, carbohydrates, amino acids, and fat in liquid solutions via a catheter that has been inserted and secured into a vein.
Source: Webnd.com
Because the disease can also spark vitamin and mineral deficiencies, patients may also need supplements. For people with severe small intestine inflammation, doctors sometimes prescribe steroids.
The standard treatment of disease patients calls for complete avoidance of gluten for life. The principles of a gluten free diet include:
Avoid all foods made from wheat, rye, and barley. Examples are breads, cereals, pasta, crackers, cakes, pies, cookies, and gravies.
Avoid oats. Some patients with celiac disease can tolerate oats in the diet. But long-term safety of oats in celiac disease patients is unknown. Also some oat preparations can be contaminated with wheat. Thus, it is probably best to avoid oats at least during the initial treatment with a gluten free diet. Once disease remission is achieved with a strict gluten free diet, small quantities of oats can be reintroduced into the diet under medical supervision.
Pay attention to processed foods that may contain gluten. Wheat flour is a common ingredient in many processed foods. Examples of foods that may contain gluten, to name only a few, include:
- canned soups,
- salad dressings,
- ice cream,
- candy bars,
- instant coffee,
- luncheon meats,
- ketchup,
- mustard,
- processed and canned meats,
- yogurt,
- sausages and,
- pasta.
Beware of tablets, capsules, and vitamin preparations that contain gluten. Wheat starch is commonly employed as a binding agent in tablets and capsules. Gluten also can be found in many vitamin products, and cosmetic products such as lipstick.
Avoid beer. It is all right to drink wine, brandy, whiskey and other non-wheat or barley alcohol (in moderation!)
Avoid milk and other dairy products that contain lactose. Untreated patients with celiac disease often are lactose intolerant. With successful treatment, dairy products can be reintroduced slowly into the diet later. It is alright to consume fish, fresh meats, rice, corn, soybean, potato, poultry, fruits, vegetables, and dairy products (for patients who are not lactose intolerant)
Consult dietitians and national celiac disease societies for lists of gluten free foods. Read the food and product labels before buying or consuming any product. This is necessary because a manufacturer may change a product's ingredients at any time. A product that was gluten-free in the past may now contain gluten. Even branded products may be gluten free in one country but contain gluten in another country. If one is not certain after reading the labels, call the manufacturer.
Because patients with severe malabsorption can develop vitamin and mineral deficiencies, vitamin and mineral supplements are important. All patients should take a multivitamin daily. Patients with iron deficiency anemia should be treated with iron. Patients with anemia due to folate or B12 deficiency should be treated with folic acid and B12. Patients with an abnormal ProTime should be treated with vitamin K. Patients with low blood calcium levels or with osteoporosis should be treated with calcium and vitamin D supplements.
In most patients, a gluten free diet will result in improvements in symptoms within weeks. Many patients report symptom improvements within 48 hours. In children with celiac disease, the response to a gluten free diet can be dramatic. Not only will diarrhea and abdominal discomfort subside, but behavior also improves, and growth resumes (with rapid catch up in height). These improvements in symptoms are followed by reappearance of intestinal villi. Complete normalization of the intestinal villi may take months. In many adult patients, the improvement in symptoms is followed by only partial regeneration of intestinal villi. In patients with dermatitis herpetiformis, the skin lesions also improve with a gluten free diet.
Many patients with celiac disease may not understand the importance of life-long adherence to a gluten free diet. A recent study found that among patients diagnosed at least 20 years earlier with celiac disease, only half of the patients were following a strict gluten-free diet. The primary reason that patients followed the diet was to prevent symptoms-not to prevent complications. There was evidence of mild iron deficiency and abnormal bone density each in one-third of the patients, suggesting that the lack of adherence to the diet was having health consequences.
What if patients fail to respond to gluten free diet?
Failure to respond to a gluten free diet can be due to several reasons:
- Patients are not following a strict gluten free diet and are still eating small amounts of gluten.
- Patients are unknowingly ingesting unsuspected sources of gluten such as starch, binders and fillers in medications or vitamins.
- Patients may have another co-existing condition such as irritable bowel syndrome, bacterial overgrowth of the small bowel, microscopic colitis, or pancreatic insufficiency that are causing the symptoms.
- Patients may have refractory disease, or complications of celiac disease.
What is refractory celiac disease?
Refractory celiac disease is a rare condition in which the symptoms of celiac disease (and the loss of villi) do not improve despite many months of a strict gluten free diet. Before making a diagnosis of refractory celiac disease it is important to exclude complications of celiac disease and other co-existing conditions that can produce similar symptoms. It is believed by many knowledgeable physicians that refractory celiac disease is a malignant condition, that is, it is a cancer.
What is the treatment for refractory celiac disease?
The treatment of refractory celiac disease is first to make sure that all gluten is eliminated from the diet. If there still is no improvement, medications are used. Corticosteroids such as prednisone have been used successfully in treating some patients with refractory celiac disease. Immuno-suppressive drugs (medications that suppress a person's immune system) such as azathioprine and cyclosporine also have been used. (These drugs also are used in treating some types of cancer.) Corticosteroids and immunosuppressive drugs are potent medications with potentially serious side effects. Many patients with refractory celiac disease are malnourished and have weakened immune systems, and corticosteroids and immunosuppressive agents can further increase their risk of serious infections. Thus doctors experienced with treating celiac disease should monitor treatment of refractory celiac disease.
Unfortunately in some patients with refractory celiac disease, malabsorption and malnutrition progress despite drugs. In these patients the intravenous route is the only way to deliver nutrition. Total parenteral nutrition (TPN) is a way of delivering calories, carbohydrates, amino acids, and fat in liquid solutions via a catheter that has been inserted and secured into a vein.
Source: Webnd.com
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