Treatment and Follow-up

TREATMENT

The only treatment for celiac disease presently is a strict gluten free diet for life. There is no medication needed except for supplements for nutrition deficiencies, which need to be taken for 6-12 months after diagnosis.

The intestine starts healing almost immediately after gluten is removed from the diet though it may take up to two years for it to heal completely. As the intestines start to recover, there is visible improvement in symptoms within 2-4 weeks, especially gastrointestinal symptoms.

tTG value too starts to reduce, though it may take 2 years to normalize. One must remember however, that a normal tTG value does not mean that the individual has been cured but only that the disease is under control with gluten free diet. These patients, their family and friends do deserve a pat on their back but does not give them a green signal to restart gluten!

Left untreated or undiagnosed, celiac disease could result in many complications like anemia, stunted growth, malnutrition, lack of stamina, liver disease, osteoporosis, infertility, cancer and development of other autoimmune conditions. Some individuals may just feel unwell, tired and unable to concentrate on their studies or job.

Compliance to a strict gluten free diet is thus critical. Accidental or frequent ingestion of even small amounts of gluten can cause short term symptoms and long term damage.

In rare instances, refractory celiac disease occurs where the intestine does not heal despite all precautions.

FOLLOW – UP

Follow-up visits are thus essential to evaluate the response to gluten free diet. Follow-ups are recommended after 2 weeks, 3 months, 6 months of diagnosis and thereafter annually. Refer to the gluten free health card for the tests which one must undergo at the time of follow-up and for keeping track of one’s health.

Biopsy need not be repeated if the individual is doing well on gluten free diet. Only in certain cases – where the diagnosis was not clear, response is not as expected or the diagnosis had taken place before the age of 2 years – the doctor may consider repeating the biopsy.