Celiac disease medical therapy: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
Line 48: Line 48:
==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Pharmacologic medical therapies for celiac disease include gluten-free diet.<ref name="pmid24355936">{{cite journal |vauthors=Schuppan D, Zimmer KP |title=The diagnosis and treatment of celiac disease |journal=Dtsch Arztebl Int |volume=110 |issue=49 |pages=835–46 |year=2013 |pmid=24355936 |pmc=3884535 |doi=10.3238/arztebl.2013.0835 |url=}}</ref><ref name="pmid15825119">{{cite journal |vauthors=Kupper C |title=Dietary guidelines and implementation for celiac disease |journal=Gastroenterology |volume=128 |issue=4 Suppl 1 |pages=S121–7 |year=2005 |pmid=15825119 |doi= |url=}}</ref>
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patient should be referred to a dietitian once the diagnosis of celiac disease is made.
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===
===Celiac Disease===


* '''1 Stage 1 - Name of stage'''
* '''Dietary modification'''
** 1.1 '''Specific Organ system involved 1'''
** 1.1 '''Gluten-free diet (GFD)'''
*** 1.1.1 '''Adult'''
*** 1.1.1 '''Storage protein not allowed'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
***:* Wheat
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
***:* Rye
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
***:* Barley,
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***:* Spelt
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***:* Kamut
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
***:* Emmer wheat
*** 1.1.2 '''Pediatric'''
***:* Einkorn wheat
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***:* Green spelt
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
*** 1.1.2 '''Storage protein allowed'''
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
**** 1.1.2.1 Comparatively more nutritious (more nutritious than other starches in the Gluten free diet; higher fiber, protein, calcium, iron.)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Amaranth
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Buckwheat
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
***** Legumes
****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
***** Quinoa
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Sorghum/Milo
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Soy
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Tef/Teff
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
**** 1.1.2.2 Comparatively less nutritious
** 2.1 '''Specific Organ system involved 2'''
***** Arrowroot
*** 2.1.1 '''Adult'''
***** Corn/maize
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
***** Indian Rice Grass (Montina)
*** 2.1.2  '''Pediatric'''
***** Mesquite
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
***** Millet
 
***** Nuts
* 2 '''Stage 2 - Name of stage'''
***** Potato
** 2.1 '''Specific Organ system involved 1 '''
***** Rice
**: '''Note (1):'''
***** Tapioca
**: '''Note (2)''':
***** Wild rice
**: '''Note (3):'''
*****Pure oats (oats that are not contaminated by gluten)<ref name="pmid17948135">{{cite journal |vauthors=Rashid M, Butzner D, Burrows V, Zarkadas M, Case S, Molloy M, Warren R, Pulido O, Switzer C |title=Consumption of pure oats by individuals with celiac disease: a position statement by the Canadian Celiac Association |journal=Can. J. Gastroenterol. |volume=21 |issue=10 |pages=649–51 |year=2007 |pmid=17948135 |pmc=2658132 |doi= |url=}}</ref>
*** 2.1.1 '''Adult'''
***** Wheat starch
**** Parenteral regimen
****: '''Note:''' The 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.
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
** 2.1 '''Nutritional supplements''' (must be strict gluten-free)
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
**::* Fiber
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**::* Iron
**** Oral regimen
**::* Calcium
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
**::* Vitamin D
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
**::* Magnesium
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
**::* Zinc
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**::* Vitamin B complex (folate, niacin, vitamin B12, riboflavin)
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**::: '''Note:''' Even while on a diet, health-related quality of life (HRQOL) may be decreased in people with coeliac 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.<ref name="pmid16772832">{{cite journal |vauthors=Häuser W, Gold J, Stein J, Caspary WF, Stallmach A |title=Health-related quality of life in adult coeliac disease in Germany: results of a national survey |journal=Eur J Gastroenterol Hepatol |volume=18 |issue=7 |pages=747–54 |year=2006 |pmid=16772832 |doi=10.1097/01.meg.0000221855.19201.e8 |url=}}</ref>
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''  
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)  
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
 
 
 
* Nutrition referral--strict gluten-free diet
* Vitamin/mineral supplements until deficiencies resolve with gluten-free diet
 
===Diet===
{{main|Gluten-free diet}}
 
Presently, the only effective treatment is a life-long [[gluten-free diet]].<ref>{{cite journal | author = Kupper C | title = Dietary guidelines and implementation for celiac disease | journal = Gastroenterology | volume = 128 | issue = 4 Suppl 1 | pages = S121-7 | year = 2005 | id = PMID 15825119}}</ref> No medication exists that will prevent damage, or prevent the body from attacking the gut when gluten is present. Strict adherence to the diet allows the intestines to heal, leading to resolution of all symptoms in the vast majority of cases and, depending on how soon the diet is begun, can also eliminate the heightened risk of osteoporosis and intestinal cancer.<ref>{{cite journal | author = Treem W | title = Emerging concepts in celiac disease | journal = Curr Opin Pediatr | volume = 16 | issue = 5 | pages = 552-9 | year = 2004|id = PMID 15367850}}</ref> [[Dietician]] input is generally requested to ensure the patient is aware which foods contain gluten, which foods are safe, and how to have a balanced diet despite the limitations. In many countries gluten-free products are available on [[Medical prescription|prescription]] and may be reimbursed by [[health insurance]] plans. More manufacturers are producing gluten-free products, some of which are almost indistinguishable from their gluten-containing counterparts.
 
The diet can be cumbersome; while young children can be kept compliant by their parents, teenagers may wish to hide their problem or rebel against the dietary restrictions, risking relapse. Many food products contain traces of gluten even if apparently wheat-free. Gluten-free products are usually more expensive and harder to find than common wheat-containing foods.
 
Even while on a diet, health-related quality of life (HRQOL) may be decreased in people with coeliac 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.<ref>{{cite journal | author = Häuser W, Gold J, Stein J, Caspary W, Stallmach A | title = Health-related quality of life in adult coeliac disease in Germany: results of a national survey | journal = Eur J Gastroenterol Hepatol | volume = 18 | issue = 7 | pages = 747-54 | year = 2006 | id = PMID 16772832}}</ref>


===Refractory disease===
===Refractory disease===

Revision as of 18:28, 12 September 2017

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:

Overview

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR   The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Medical Therapy

  • Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
  • Pharmacologic medical therapies for celiac disease include gluten-free diet.[1][2]
  • Patient should be referred to a dietitian once the diagnosis of celiac disease is made.
  • Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Celiac Disease

  • 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 Gluten free diet; 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)[3]
          • Wheat starch
          Note: The 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 coeliac 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.[4]

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. If alternative causes have been eliminated, steroids or immunosuppressants (such as azathioprine) may be considered in this scenario.

References

  1. ↑ Schuppan D, Zimmer KP (2013). "The diagnosis and treatment of celiac disease". Dtsch Arztebl Int. 110 (49): 835–46. doi:10.3238/arztebl.2013.0835. PMC 3884535. PMID 24355936.
  2. ↑ Kupper C (2005). "Dietary guidelines and implementation for celiac disease". Gastroenterology. 128 (4 Suppl 1): S121–7. PMID 15825119.
  3. ↑ Rashid M, Butzner D, Burrows V, Zarkadas M, Case S, Molloy M, Warren R, Pulido O, Switzer C (2007). "Consumption of pure oats by individuals with celiac disease: a position statement by the Canadian Celiac Association". Can. J. Gastroenterol. 21 (10): 649–51. PMC 2658132. PMID 17948135.
  4. ↑ Häuser W, Gold J, Stein J, Caspary WF, Stallmach A (2006). "Health-related quality of life in adult coeliac disease in Germany: results of a national survey". Eur J Gastroenterol Hepatol. 18 (7): 747–54. doi:10.1097/01.meg.0000221855.19201.e8. PMID 16772832.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Celiac_disease_medical_therapy&oldid=1351001"