Page 6 - 04- Celiac Disease

TREATMENT

GENERAL MEASURES
Gluten-free diet (GFD)—avoid wheat, barley, and rye.
– Rice, corn, and nut flour are safe and palatable substitutes (1)[C].
– Grains: uncontaminated oats, rice, corn, tapioca, quinoa, amaranth, sorghum
Levels of IgA antigliadin normalize with gluten abstinence.
Lifelong abstinence is required; immune response to gluten will recur with resumption of
gluten intake.

MEDICATION
First Line
Usually no medications. GFD is primary treatment.

Second Line
In refractory disease, consult with GI for consideration of choice, dosing, and duration of
second-line agents:
– Steroids (prednisone (1)[C] or budesonide (1)[B])
– Azathioprine (used with caution; use may lead to lymphoma) (1)[C]
– Cyclosporine
– Infliximab
– Cladribine
Depending on disease severity, patients may develop nutritional deficiencies that require
appropriate supplementation.
ISSUES FOR REFERRAL
Additional nutritional support with qualified dietitian
Refractory celiac disease
Child with positive celiac serology
COMPLEMENTARY & ALTERNATIVE MEDICINE
Many alternative therapies are under development. Future treatment may include predigestion
of gluten with peptidase, tight junction blockade, transglutaminase 2 or HLA DQ2/DQ8
blockers, and induction of immune tolerance (4).
Patients with celiac disease are at increased risk for pneumococcal infection. Pneumococcal
vaccination should be considered, especially for those between the ages of 15 and 64 years
who may not have received vaccination.

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS
Consultation with registered dietitian
Screen for osteoporosis and treat accordingly.
Follow-up with GI at 3 to 6 months for serology and 12 months for repeat biopsy if indicated
Patient Monitoring