Celiac disease medical therapy

Celiac disease Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Celiac disease from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy Life Style Modifications Pharmacotherapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Celiac disease medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Celiac disease medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
National Guidelines Clearinghouse
NICE Guidance
FDA on Celiac disease medical therapy
CDC on Celiac disease medical therapy
Celiac disease medical therapy in the news
Blogs onCeliac disease medical therapy
Directions to Hospitals Treating Celiac disease
Risk calculators and risk factors for Celiac disease medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]

Overview

Preferred therapy for celiac disease is dietary modification which includes gluten-free diet. Patients with celiac disease should be referred to a dietitian once the diagnosis of celiac disease is made. A minority of patients suffer from refractory disease, which means that they do not improve with a gluten-free diet. Pharmocotherapy is used if alternative causes are eliminated and dietary modification is not beneficial. Pharmacotherapy include steroids, azathioprine, cyclosporin, and monoclonal antibodies.

Medical Therapy

• Dietary modification is the preferred theray for celiac disease, which includes gluten-free diet.
• Patient should be referred to a dietitian once the diagnosis of celiac disease is made.

Celiac Disease

• 1 Dietary modification
  • 1.1 Gluten-free diet (GFD)
    • 1.1.1 Storage protein not allowed

      • Wheat
      • Rye
      • Barley
      • Spelt
      • Kamut
      • Emmer wheat
      • Einkorn wheat
      • Green spelt

    • 1.1.2 Storage protein allowed
      • 1.1.2.1 Comparatively more nutritious (more nutritious than other starches in the GFD; higher fiber, protein, calcium, iron.)
        • Amaranth
        • Buckwheat
        • Legumes
        • Quinoa
        • Sorghum/Milo
        • Soy
        • Tef/Teff
      • 1.1.2.2 Comparatively less nutritious
        • Arrowroot
        • Corn/maize
        • Indian Rice Grass (Montina)
        • Mesquite
        • Millet
        • Nuts
        • Potato
        • Rice
        • Tapioca
        • Wild rice
        • Pure oats (oats that are not contaminated by gluten)
        • Wheat starch

        Note: There is evidence that wheat starch is a safe and well-tolerated addition to gluten-free diet.However, wheat starch is not currently accepted in the United States or Canadian GFD.

  • 2.1 Nutritional supplements (must be strict gluten-free)

    • Fiber
    • Iron
    • Calcium
    • Vitamin D
    • Magnesium
    • Zinc
    • Vitamin B complex (folate, niacin, vitamin B12, riboflavin)

    Note: Even while on a diet, health-related quality of life (HRQOL) may be decreased in people with celiac disease. Some have persisting digestive symptoms or dermatitis herpetiformis, mouth ulcers, osteoporosis and fractures. Symptoms suggestive of irritable bowel syndrome may be present, and there is an increased rate of anxiety, fatigue, dyspepsia and musculoskeletal pain.

Refractory disease

A tiny minority of patients suffer from refractory disease, which means they do not improve on a gluten-free diet. This may be because the disease has been present for so long that the intestines are no longer able to heal on diet alone, or because the patient is not adhering to the diet, or because the patient is consuming foods that are inadvertently contaminated with gluten. Pharmocotherapy is used if alternative cause is elimiated.

• 1 Steroids

• Preferred regimen(1): Prednisone 0.5–1 mg/kg q24h
• Preferred regimen(2): Budesonide 9 mg q24h
• Preferred regimen(3): Prednisone 0.5–1 mg/kg q24h and azathioprine 2 mg/kg q24h combination

• 2 Immunosupressive drugs (Used in steroid dependent or steroid refractory disease)
  • 2.1 Antiproliferative agents

• Preferred regimen(1): Azathioprine 2 mg/kg q24h

• • 2.2 Calcineurin Inhibitors:

• Preferred regimen(1): Cyclosporine 5 mg/kg q24h PO

• • 2.3 Monoclonal antibodies

• Preferred regimen(1): Infliximab 5 mg/kg q24h
• Preferred regimen(2): Alemtuzumab 30 mg twice a week per 12 weeks