Celiac Disease Treatment
What is the Treatment for Celiac Disease? continued...
Following a gluten-free diet should 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, finger-like surface projections in the small intestine that are damaged by gluten.
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 will gradually improve with a gluten-free diet. Often a medication called dapsone may be used for a short time to speed up healing.
Many patients with celiac disease may not understand the importance of life-long adherence to a gluten-free diet. Many of those affected do not follow the diet closely. People who are poor and undereducated are most likely to have trouble following the diet, as are people who were diagnosed when they were children.
What if a Person Fails to Respond to a Gluten-Free Diet?
Failure to respond to a gluten-free diet can be due to several reasons:
- A person doesn't have celiac disease but a condition that mimics it
- A person is unknowingly ingesting unsuspected sources of gluten such as starch, binders and fillers in medications or vitamins
- A person 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
- A person 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 intestinal 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 experts that sometimes refractory celiac disease can be a pre-malignant or precancerous condition.
What is the Treatment for Refractory Celiac Disease?
The treatment for 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. Immunosuppressive drugs (medications that suppress a person's immune system), such as azathioprine and cyclosporine, also have been used. 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.
Other new treatments include biologics and stem cell transplants, but these may also have very serious side effects. Thus, doctors experienced with treating celiac disease should monitor treatment of refractory celiac disease.
Unfortunately, in some people diagnosed with refractory celiac disease, malabsorption and malnutrition progress despite drugs. In these cases, nutrition must be given intravenously. 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.