Treatment

 

Managing Celiac Disease and Gluten Sensitivity

There is no cure for celiac disease.

The management of celiac disease and gluten sensitivity is a gluten-free diet for life¹ that meets the nutritional needs of the individual.This diet is highly effective for regaining health because it eliminates the cause of health problems originated by contact with gluten.

Treatment for celiac disease should begin only after a complete diagnostic evaluation including serology (blood test to detect antibodies) and biopsy of small intestine tissue.The institution of a gluten-free diet should result in prompt and often dramatic improvement.

Symptoms may take 3 months to 6 months to resolve.Complete healing of the intestines may take up to 5 years or even longer in some individuals, especially in the elderly.Recovery is more rapid and complete in children than in adults.²

The following are six key elements in the management of individuals affected by celiac disease as advanced by the National Institutes of Health:

• Consultation with a skilled dietitian
• Education about celiac disease
• Lifelong adherence to a gluten-free diet
• Identification and treatment of nutritional deficiencies and other manifestations
• Access to an advocacy group
• Continuous long-term follow-up by a multidisciplinary team

Consultation with a Skilled Dietitian

Gluten is so widely used that newly diagnosed patients need detailed lists of the foodstuffs to avoid, as well as a diet plan. Expert advice from a dietician familiar with celiac disease is recommended. Properly kept food diaries can be instrumental in identifying gluten sources of accidental ingestion.

Education about Celiac Disease

Learning about celiac disease and how to identify gluten-containing products is associated with improved self-management. Visual aids and Internet resources are helpful.

Lifelong Adherence to a Gluten-free Diet

The management of celiac disease is a lifelong gluten-free diet. A gluten-free diet is defined as one that excludes wheat, barley, rye, and oats.Even small quantities of gluten are harmful, preventing remission or inducing relapse.

The strict definition of a gluten-free diet remains controversial due to the lack of an accurate method to detect gluten in food products and the lack of scientific evidence for what constitutes a safe amount of gluten ingestion. Therefore, a zero tolerance approach to gluten ingestion is prudent.

Identification and Treatment of Nutritional Deficiencies and Other Manifestations

Health care providers should consider and treat deficiencies including vitamin, mineral, protein and essential fatty acids. Mild cases may not require supplementation. Severe cases may require comprehensive replacement.

Access to an Advocacy Group

Participation in an advocacy group is an effective means of promoting adherence to a gluten-free diet and may provide emotional and social support. There are hundreds of celiac disease support groups in the United States.

Continuous Long-term Follow Up by a Multidisciplinary Team

Following initial diagnosis and treatment, individuals should return for periodic visits with the physician and dietitian to assess symptoms and dietary adherence and monitor for complications. In children, this includes evaluation of growth and development. During these visits, health care providers can reinforce the benefits of adhering to a strict gluten-free diet for life.

Repeat serologic testing may be used to assess response to treatment but that this may be used to assess improvement is unproven. These tests may take a prolonged time (up to 1 year) to normalize, especially in adults, and may not correlate with improved histology. Persistent elevated serological levels may suggest lack of adherence to a gluten-free diet or unintended gluten ingestion.

Individuals who do not respond to a gluten-free diet require reevaluation. No established approach exists to screen for complications of celiac disease.

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Resources:

1. National Institutes of Health, “National Institutes of Health Consensus Development Conference Statement, Celiac Disease,” August 9, 2004;1-14.
2. Murray, J., “The widening spectrum of celiac disease.” American Journal of Clinical Nutrition. Mar 1999;69(3):354-365.