At present there is no cure or specific medicinal treatment for celiac disease. The present treatment of celiac disease revolves around making the diet completely free of gluten that induces hypersensitivity and brings on symptoms.
In patients with celiac disease, gluten free diet must be adhered to for life. Primarily wheat, barley, and rye are avoided.
In 95% of patients with celiac disease, oats are not toxic but less than 5% patients with celiac disease or with dermatitis herpetiformis, oats may also trigger symptoms and need to be avoided.
Further many commercially available oats are not completely free of contamination with other grains and are thus not generally advised.
Diet is based on rice and corn as staple cereals. Gluten free foods include rice, corn, sorghum, millet, buckwheat, beans, peas, quinoa, potatoes, soybean, tapioca, amaranth, nuts, fruits, milk and dairy products, meat, fish, eggs etc.
The initial approach is to prepare natural and gluten free diets with the help of a diet advisor or support groups. Apart from diet advice the factors to be kept in mind are:-
- Prevention of iron and folate deficiency due to diet changes. Iron and folates need to be supplemented in diet in patients with celiac disease. Patients are advised to take high iron and folate containing foods.
- A gluten-free diet is typically low in fibre. Patients should be advised to eat a high-fibre diet supplemented with whole-grain rice, maize, and vegetables.
- Bone density tests are advised on a regular basis to screen for osteoporosis and calcium and vitamin D supplementation may be necessary.
- Gluten is also used in some medications. Care must be taken not to take medications containing gluten. Similarly several foods and cosmetics (e.g. lipsticks) may use gluten as an additive. These agents should be carefully screened before use.
The response to a gluten-free diet in terms of improvement in symptoms is rapid among most patients (within 2 weeks). The rate of response varies between patients. The quality of life significantly improves on a gluten-free diet with marked improvement in symptoms. Adolescents may have difficulty in complying with the gluten free diet.
In 2006, the American Dietetic Association updated its recommendations for a gluten-free diet.
Persistence of symptoms
Symptoms may persist despite initiation and maintenance of gluten free diets. The persistence of symptoms is almost always caused by continued ingestion of gluten. Reasons for persistence of symptoms thus includes:-
- Commonest cause is inadvertent intake of gluten in diet
- Mistaken diagnosis
- Lactose or fructose intolerance or other food intolerances
- Microscopic colitis or Collagenous colitis or collagenous sprue
- Irritable bowel syndrome
- Ulcerative jejunitis
- Pancreatic insufficiency
- Enteropathy-associated T-cell lymphoma
- Refractory celiac disease resistant to treatment
Management of severe symptoms
Patients presenting with severe symptoms need hospital admission along with intravenous fluid supplementation, electrolytes administration, parenteral nutrition and occasionally, steroids.