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Celiac Disease Treatment

The mainstay of treatment is a strict lifelong adherence to a GFD, in which the patient must avoid permanently all kinds of food products containing some wheat, rye, barley and oat. Commonly substituted grains, including rice and corn taken directly, or in the form of fl our derived from them.

GFD is a very healthy and complete diet, very well balanced in all the immediate principles and rich enough in all kind of vitamins and minerals; it is the only type of treatment required for these patients. Compliance is a diffi cult task, at any age, because the wheat fl our is present in a great part of foods or as an additive product. Patients whose disease does not respond to dietary treatment should undergo a systematic review[26,27]. The only gluten-free cereal is corn and is, therefore, allowed in the celiac patientís diet whether raw or roasted, in salads, etc. Corn flour, if pure in its composition (100%) regarding preparation, processing and manufacture, may be used for bread, cookies, baby food and sweets, which may render a celiac patientís diet more bearable.

Dairy products must be avoided when starting on a GFD, as secondary lactase deficiency is often associated with celiac disease. After 1-2 mo on a GFD, milk derivatives may be gradually reintroduced as long as the patient has no complaints following ingestion, since lactose intolerance is secondary to gluten, and usually regresses within three months with strict gluten-free diet adherence.

On the other hand, dietary calcium and proteins are essential to correct existing mineral deficiencies, given the high prevalence of osteoporosis seen in celiac patients[28]. Beer must be completely avoided, even from alcoholfree brands, as its manufacture involves the fermentation of various gluten-containing cereals, including barley and rye. The same can be said of all kinds of whisky, obtained from malt distillation procedures. Approximately 70% of patients experience symptoms improvement after 2 wk on a GFD.

The rapidity and extent of histological regression are unpredictable, but there is invariably a delay against clinical improvement, which may not be apparent in repeated biopsies until after three to six months. While histological fi ndings usually regress in children, one half of adults only achieve a partial histological resolution. When there is severe iron-deficiency anemia, the administration of iron preparations through the intravenous or intramuscular route is recommended for a few months (2 or 3), in order to shorten the recovery time. The two most important questions to answer are if the patient truly has celiac disease and whether he/she is following a strict GFD.

The evaluation requires a review of the original biopsies and a complete assessment by an expert dietician. Several associated conditions must be ruled out including the concomitant presence of pancreatic insuffi ciency, bacterial overgrowth, lymphocytic colitis and true refractory sprue with a clonal T-cell population[29,30].

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