From the Guidelines
Heal sprue treatment involves a strict gluten-free diet, which is the only accepted treatment for celiac disease, and should be managed by a registered dietitian to ensure optimal nutritional status and compliance. The treatment of celiac disease requires elimination of the storage proteins found in wheat, rye, and barley, and the inclusion of oats and wheat starch is controversial 1. However, research supports that oats may be acceptable for patients with celiac disease and can improve the nutritional quality of the diet 1. The gluten-free diet should be implemented under the guidance of a registered dietitian, who can help patients navigate the complexities of the diet and ensure that they are getting all the necessary nutrients 1.
Some key points to consider in the treatment of celiac disease include:
- The diet and gluten-free products are often low in B vitamins, calcium, vitamin D, iron, zinc, magnesium, and fiber, so supplementation may be necessary 1
- Patients newly diagnosed or inadequately treated have low bone mineral density, imbalanced macronutrients, low fiber intake, and micronutrient deficiencies, so close monitoring is essential 1
- The impact of nutrient malabsorption caused by untreated celiac disease is well documented, and medical nutrition therapy is the only accepted treatment for management of celiac disease 1
- A recent study published in 2024 provides guidelines for best practices in monitoring established coeliac disease in adult patients, which can help clinicians improve treatment and follow-up 1
Overall, the treatment of celiac disease requires a comprehensive approach that includes a strict gluten-free diet, close monitoring, and supplementation as necessary, all under the guidance of a registered dietitian. The most recent and highest quality study, published in 2024, provides the best guidance for the treatment of celiac disease, and should be consulted for the most up-to-date recommendations 1.
From the Research
Treatment for Celiac Sprue
- The primary treatment for celiac sprue is a lifelong gluten-free diet, which allows the small intestine to heal and digestion and absorption to resume 2, 3.
- A gluten-free diet must be maintained for the rest of one's life, as celiac sprue does not go away 2.
- Oral enzyme therapy, which involves delivering enzymes capable of proteolyzing gluten to the alimentary tract, is a new therapeutic strategy being developed for celiac sprue 4.
Management of Chronic Diarrhea
- Chronic diarrhea can persist in patients with celiac sprue even after treatment with a gluten-free diet 5.
- The causes of chronic diarrhea in these patients can include microscopic colitis, steatorrhea secondary to exocrine pancreatic insufficiency, dietary lactose or fructose malabsorption, anal sphincter dysfunction, and irritable bowel syndrome 5.
- Diagnostic investigation of diarrhea in celiac sprue after treatment is warranted to determine the underlying cause 5.
Comparison with Tropical Sprue
- Tropical sprue is a disease that causes progressive villus atrophy in the small intestine, similar to celiac sprue 6.
- The treatment for tropical sprue typically involves folic acid replacement, vitamin B12 replacement, and antibiotic treatment with tetracycline 6.
- While treatment with folate and B12 can cure macrocytic anemia and improve symptoms, it does not restore villus atrophy or resolve malabsorption 6.
- Antibiotic treatment with tetracycline can normalize mucosal structure and resolve malabsorption in most patients with tropical sprue, but there is a substantial relapse rate in treated patients who return to or remain in endemic areas 6.