Celiac disease medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Celiac disease}} | {{Celiac disease}} | ||
{{CMG}}; {{AE}} {{Anmol}} | {{CMG}}; {{AE}}{{Anmol}} | ||
==Overview== | ==Overview== | ||
Preferred | Preferred theray for celiac disease is dietary modification which include [[gluten-free diet]]. Patient should be referred to a [[dietitian]] once the diagnosis of celiac disease is made. A tiny minority of patients suffer from refractory disease, which means they do not improve on a [[gluten-free diet]]. Pharmocotherapy is used if alternative causes are elimiated. Pharmacotherapy include [[Steroid|steroids]], [[azathioprine]], [[Cyclosporine|cyclosporin]], and [[monoclonal antibodies]]. | ||
==Medical Therapy== | ==Medical Therapy== | ||
*Preferred | *Preferred theray for celiac disease is dietary modification which 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> | ||
*Patient should be referred to a dietitian once the diagnosis of celiac disease is made. | *Patient should be referred to a [[dietitian]] once the diagnosis of celiac disease is made. | ||
===Celiac Disease=== | ===Celiac Disease=== | ||
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***:* Green spelt | ***:* Green spelt | ||
*** 1.1.2 '''Storage protein allowed''' | *** 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.) | **** 1.1.2.1 Comparatively more nutritious (more nutritious than other starches in the GFD; higher fiber, [[protein]], [[calcium]], [[iron]].) | ||
***** Amaranth | ***** Amaranth | ||
***** Buckwheat | ***** Buckwheat | ||
| Line 44: | Line 44: | ||
*****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> | *****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> | ||
***** Wheat starch | ***** Wheat starch | ||
****: '''Note:''' | ****: '''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) | ** 2.1 '''Nutritional supplements''' (must be strict gluten-free) | ||
**::* Fiber | **::* Fiber | ||
**::* Iron | **::* [[Iron supplements|Iron]] | ||
**::* Calcium | **::* [[Calcium supplements|Calcium]] | ||
**::* Vitamin D | **::* [[Vitamin D]] | ||
**::* Magnesium | **::* [[Magnesium]] | ||
**::* Zinc | **::* [[Zinc]] | ||
**::* Vitamin B complex (folate, niacin, vitamin B12, riboflavin) | **::* [[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 | **::: '''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]].<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> | ||
===Refractory disease=== | ===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.<ref name="pmid20332526">{{cite journal |vauthors=Rubio-Tapia A, Murray JA |title=Classification and management of refractory coeliac disease |journal=Gut |volume=59 |issue=4 |pages=547–57 |year=2010 |pmid=20332526 |pmc=2861306 |doi=10.1136/gut.2009.195131 |url=}}</ref> | 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.<ref name="pmid20332526">{{cite journal |vauthors=Rubio-Tapia A, Murray JA |title=Classification and management of refractory coeliac disease |journal=Gut |volume=59 |issue=4 |pages=547–57 |year=2010 |pmid=20332526 |pmc=2861306 |doi=10.1136/gut.2009.195131 |url=}}</ref> | ||
* 1 '''Steroids''' | * 1 '''Steroids''' | ||
:::* Preferred regimen(1): Prednisone 0.5–1 mg/kg q24h | :::* Preferred regimen(1): [[Prednisone]] 0.5–1 mg/kg q24h | ||
:::* Preferred regimen(2): Budesonide 9 mg 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 | :::* 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 '''Immunosupressive drugs''' (Used in steroid dependent or steroid refractory disease) | ||
** 2.1 '''Antiproliferative agents''' | ** 2.1 '''Antiproliferative agents''' | ||
:::* Preferred regimen(1): Azathioprine 2 mg/kg q24h | :::* Preferred regimen(1): [[Azathioprine]] 2 mg/kg q24h | ||
** 2.2 '''Calcineurin Inhibitors:''' | ** 2.2 '''Calcineurin Inhibitors:''' | ||
:::* Preferred regimen(1): Cyclosporine 5 mg/kg q24h PO | :::* Preferred regimen(1): [[Cyclosporine]] 5 mg/kg q24h PO | ||
** 2.3 '''Monoclonal antibodies''' | ** 2.3 '''Monoclonal antibodies''' | ||
:::* Preferred regimen(1): Infliximab 5 mg/kg q24h | :::* Preferred regimen(1): [[Infliximab]] 5 mg/kg q24h | ||
:::* Preferred regimen(2): Alemtuzumab 30 mg twice a week per 12 weeks | :::* Preferred regimen(2): [[Alemtuzumab]] 30 mg twice a week per 12 weeks | ||
==References== | ==References== | ||
Revision as of 19:21, 12 September 2017
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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 theray for celiac disease is dietary modification which include gluten-free diet. Patient should be referred to a dietitian once the diagnosis of celiac disease is made. A tiny minority of patients suffer from refractory disease, which means they do not improve on a gluten-free diet. Pharmocotherapy is used if alternative causes are elimiated. Pharmacotherapy include steroids, azathioprine, cyclosporin, and monoclonal antibodies.
Medical Therapy
- Preferred theray for celiac disease is dietary modification which include gluten-free diet. [1][2]
- 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)[3]
- 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.
- 1.1.2.1 Comparatively more nutritious (more nutritious than other starches in the GFD; higher fiber, protein, calcium, iron.)
- 1.1.1 Storage protein not allowed
- 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.[4]
- 1.1 Gluten-free diet (GFD)
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.[5]
- 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
References
- ↑ 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.
- ↑ Kupper C (2005). "Dietary guidelines and implementation for celiac disease". Gastroenterology. 128 (4 Suppl 1): S121–7. PMID 15825119.
- ↑ 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.
- ↑ 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.
- ↑ Rubio-Tapia A, Murray JA (2010). "Classification and management of refractory coeliac disease". Gut. 59 (4): 547–57. doi:10.1136/gut.2009.195131. PMC 2861306. PMID 20332526.