Celiac disease medical therapy: Difference between revisions

Jump to navigation Jump to search
No edit summary
Line 7: Line 7:


==Medical Therapy==
==Medical Therapy==
* Dietary modification is the preferred theray for celiac disease, which includes [[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.
===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)<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
****: '''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 supplements|Iron]]
**::* [[Calcium supplements|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]].<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 minority of celiac disease patients suffer from refractory disease, which means that they do not improve with 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 the patient is not adhering to the diet, or 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|steroid-dependent]] or [[Steroid|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
Line 20: Line 68:
** 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 for 12 weeks
:::* Preferred regimen(2): [[Alemtuzumab]] 30 mg twice a week per 12 weeks


==References==
==References==

Revision as of 15:30, 13 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: 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. [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.
    • 2.1 Nutritional supplements (must be strict gluten-free)
      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]

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

  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.
  5. 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.

Template:WH Template:WS