Celiac Disease (cont.)
What if patients fail to respond to gluten free diet?
Failure to respond to a gluten free diet can be due to several reasons:
- Patients are not following a strict gluten free diet
and are still eating small amounts of gluten.
- Patients are unknowingly ingesting unsuspected
sources of gluten such as starch, binders and fillers in medications or
vitamins.
- Patients may have another co-existing condition such
as irritable bowel syndrome,
bacterial overgrowth of the small bowel, microscopic colitis,
or pancreatic insufficiency that are causing the symptoms.
- Patients may have refractory disease, or complications of celiac disease.
What is refractory celiac disease?
Refractory celiac disease is a rare condition in which the symptoms of celiac disease
(and the loss of villi) do not improve despite many months of a strict gluten
free diet. Before making a diagnosis of refractory celiac disease it is important to
exclude complications of celiac disease and other co-existing conditions that can
produce similar symptoms. It is believed by many knowledgeable physicians that refractory celiac disease is a malignant condition, that is, it is a cancer.
What is the treatment for refractory celiac disease?
The treatment of refractory celiac disease
is first to make sure that all gluten is eliminated from the diet. If there
still is no improvement, medications are used.
- Corticosteroids such as prednisone have been used successfully in treating some patients with refractory
celiac disease.
- Immuno-suppressive drugs (medications that suppress a person's immune
system) such as azathioprine
(Imuran, Azasan) and cyclosporine also have been used. (These drugs also are used in treating some types of cancer.)
- Corticosteroids and immunosuppressive drugs are potent medications with
potentially serious side effects. Many patients with refractory
celiac disease are malnourished and have weakened immune systems, and corticosteroids and
immunosuppressive agents can further increase their risk of serious infections.
Thus doctors experienced with treating celiac disease should monitor treatment of
refractory celiac disease.
Unfortunately in some patients with refractory celiac disease,
malabsorption and malnutrition progress despite drugs. In these patients
the intravenous route is the only way to deliver nutrition. Total parenteral nutrition (TPN) is
a way of delivering calories, carbohydrates, amino acids, and fat in liquid
solutions via a catheter that has been inserted and
secured into a vein.
Next: What are the complications of celiac disease? »
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