Treatment for Celiac Disease

How do doctors treat celiac disease?

Gluten-free diet

Doctors treat celiac disease by helping people to follow a gluten-free diet. Gluten is a protein found naturally in certain grains, including wheat, barley, and rye. Gluten is also added to many other foods and products. In people who have celiac disease, consuming gluten triggers an abnormal immune system reaction that damages the small intestine.

A registered dietitian will teach you how to avoid gluten while following a healthy diet.

Symptoms greatly improve for most people with celiac disease who stick to a gluten-free diet. For most people, following a gluten-free diet will heal damage in the small intestine and prevent more damage. Many people see symptoms improve within days to weeks of starting the diet.⁶

Your doctor will explain the gluten-free diet and may refer you to a registered dietitian who specializes in treating people who have celiac disease. The dietitian will teach you how to avoid gluten while following a healthy diet and recommend substitutes for foods that contain gluten. He or she will help you

• check food and product labels for gluten
• design everyday meal plans
• make healthy choices about foods and drinks
  

Avoiding medicines and other products that may contain gluten

In addition to prescribing a gluten-free diet, your doctor will want you to avoid all hidden sources of gluten. If you have celiac disease, ask a pharmacist about ingredients in

• herbal and nutritional supplements
• prescription and over-the-counter medicines
• vitamin and mineral supplements

Medicines are rare sources of gluten. Even if gluten is present in a medicine, it is likely to be in such small quantities that it would not cause any symptoms.

Other products can be hidden sources of gluten. You may take in small amounts of gluten if you consume these products, use them around your mouth, or transfer them from your hands to your mouth by accident. Products that may contain gluten include

• children’s modeling dough, such as Play-Doh
• cosmetics
• lipstick, lip gloss, and lip balm
• skin and hair products
• toothpaste and mouthwash
• communion wafers

Reading product labels can sometimes help you avoid gluten. Some companies label their products as being gluten-free. In the United States, products labelled gluten-free must have less than 20 parts per million of gluten, which should not be a problem for the vast majority of people. If a label doesn’t tell you what is in a product, ask the company that makes the product for an ingredients list. You cannot assume that the product is gluten-free.

Treatments for symptoms or complications

A gluten-free diet will treat or prevent many of the symptoms and complications of celiac disease. Some symptoms may take longer to get better than others, and some symptoms may need additional help.

Dermatitis herpetiformis may not go away until a person has been following a gluten-free diet for 6 months to 2 years.⁷ In some cases, doctors may prescribe a medicine, such as dapsone, to help treat dermatitis herpetiformis until the rash is under control with a gluten-free diet alone.

In untreated celiac disease, damage to the small intestine can lead to malabsorption and malnutrition. When you are diagnosed with celiac disease, your doctor may test you for low levels of certain vitamins and minerals and may recommend or prescribe supplements if you need them. For safety reasons, talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices.

When you are diagnosed with celiac disease, your doctor may recommend additional testing if you are at risk for certain complications. For example, doctors may order a bone mineral density test to check for osteoporosis.

Follow-up

Your doctor may recommend regular follow-up visits to make sure symptoms and health problems related to celiac disease are improving on a gluten-free diet. Follow-up may include blood tests to check levels of certain antibodies, which are higher in untreated celiac disease but typically return to normal after treatment. In some cases, doctors may recommend additional biopsies to find out if the small intestine has healed.

What if a gluten-free diet isn't working?

If you continue to have celiac disease symptoms while you are following a gluten-free diet, talk with your doctor or a registered dietitian, who can help you find the cause. In about 20 percent of people with celiac disease, symptoms continue or come back even while they are following a gluten-free diet.⁷ Symptoms may be caused by consuming small amounts of gluten, other health problems, or refractory celiac disease.

Consuming small amounts of gluten

If your symptoms continue or come back after you start a gluten-free diet, you may still be eating or drinking a small amount of gluten. Keep a food journal and talk with your doctor and a registered dietitian about your diet and products you use that might contain gluten. Finding and avoiding all sources of gluten may help your symptoms improve. Hidden sources of gluten include additives made with wheat, such as

• modified food starch
• malt flavoring
• preservatives
• stabilizer

Other health problems

Your doctor may order tests to confirm the diagnosis of celiac disease and check for other health problems. Health problems that cause symptoms similar to those of celiac disease and may occur along with celiac disease include irritable bowel syndrome, lactose intolerance, microscopic colitis, problems with the pancreas, or small intestinal bacterial overgrowth.

Refractory celiac disease

Refractory celiac disease is a rare condition in which symptoms and damage to the small intestine continue or come back, even while a person is following a strict gluten-free diet. Refractory celiac disease may lead to complications, such as malnutrition or a type of cancer called enteropathy-associated T-cell lymphoma.

Doctors may recommend additional testing and treatments to diagnose and manage refractory celiac disease.

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