What is the treatment for celiac disease?

Treatment of Celiac Disease

The only effective and safe treatment for celiac disease is strict lifelong adherence to a gluten-free diet (GFD), which requires complete elimination of all products containing wheat, rye, and barley proteins. 1, 2

Core Dietary Management

• A gluten-free diet requires elimination of storage proteins found in wheat, rye, barley, and hybrids of these grains (such as kamut and triticale) 1
• Patients must strictly avoid all gluten-containing products for life to prevent symptoms, intestinal damage, and long-term complications 1, 2
• Pure oats may be acceptable for most patients with celiac disease and can improve nutritional quality, but should be introduced slowly with monitoring for adverse reactions due to potential commercial contamination 1, 2
• Alternative gluten-free grains such as rice, corn, buckwheat, amaranth, quinoa, millet, and sorghum should be incorporated to improve the nutritional profile 1, 2, 3

Nutritional Considerations

• Newly diagnosed patients should be referred to a registered dietitian for nutritional assessment and counseling about implementing a gluten-free diet 1, 2
• Testing for micronutrient deficiencies including iron, folate, vitamin D, and vitamin B12 is recommended at diagnosis 1, 2
• Gluten-free products are often low in B vitamins, calcium, vitamin D, iron, zinc, magnesium, and fiber, requiring careful attention to nutritional adequacy 1, 4
• A balanced GFD should include naturally gluten-free foods and certified processed gluten-free products to ensure nutritional adequacy 2, 3
• Weight management deserves attention during follow-up as increased obesity has been observed in celiac patients following a gluten-free diet 1, 4

Monitoring and Follow-up

• Regular follow-up with healthcare team including physician and dietitian is essential 2
• A combination of history and serology should be used to monitor adherence to the gluten-free diet 1, 2
• Follow-up should include verification that clinical abnormalities detected on initial laboratory investigations have normalized 1, 2
• Bone mineral density assessment is recommended to evaluate for osteoporosis 2

Management of Nonresponsive Celiac Disease

• For patients with persistent or recurrent symptoms despite following a GFD, review dietary history for inadvertent gluten ingestion, which is the most common cause 1, 2
• If gluten ingestion is not identified, investigate for other conditions such as microscopic colitis, pancreatic exocrine insufficiency, bacterial overgrowth, and disaccharidase deficiency 1, 2
• Refractory sprue is a rare condition with high morbidity and mortality, defined as continued malabsorption and villous atrophy despite strict GFD adherence, and may require immunosuppression 1

Expected Benefits of Gluten-Free Diet

• Compliance with a GFD is protective against the development of non-Hodgkin's lymphoma 1, 2
• Treatment with a GFD results in substantial improvement in nutritional parameters 1
• Improvements in bone mineral density occur with the greatest improvements in the first years of the GFD 1, 2
• GFD treatment for at least 12 months can result in increased body weight, body mass index, fat mass, bone mass, and improved nutritional and biochemical status 1

Emerging Treatments

• While pharmacologic therapies for celiac disease are under development, they are intended to complement rather than replace the gluten-free diet 5
• These therapies primarily target nonresponsive celiac disease and refractory celiac disease types I and II 5

Common Pitfalls and Caveats

• Hidden sources of gluten and cross-contamination must be carefully avoided 6, 3
• Patients must learn to read food labels properly and follow strategies for dining out or traveling 6
• Nutritional deficiencies can develop on a GFD due to limited fortification of gluten-free products 4
• Non-celiac gluten sensitivity should only be considered after celiac disease has been properly ruled out through appropriate testing 1