Managment

Description:

Replacement minerals and vitamins, e.g. iron, folic acid, calcium, vitamin D, may be needed initially to replace body stores.

 Gluten-free diet for life is recommended so far. Dietary elimination of wheat, barley and rye usually produces a clinical improvement within days or weeks. Morphological improvement often takes months, especially in adults. Oats are tolerated by most coeliacs, but must not be contaminated with flour during their production. Meat, dairy products, fruits and vegetables are naturally gluten free and are all safe.

Gluten-free products can be expensive, unless subsidized by national health services. Patient support organizations such as The Coeliac Society are valuable as information sources and for advice about diet, recipes and gluten-free processed foods. Despite advice, many patients do not keep to a strict diet but maintain good health. The long-term effects of this low gluten intake are uncertain but osteoporosis can occur even in treated cases.

The usual cause for failure to respond to the diet is poor compliance. Dietary adherence can be monitored by serial tests for endomysial antibody (EMA) and tissue transglutaminase (tTG). If clinical progress is suboptimal then a repeat intestinal biopsy should be taken. If the diagnosis is equivocal on the diagnostic mucosal biopsy, or if the patient has already started on a gluten-free diet, then a gluten challenge, i.e. reintroduction of oral gluten, with evidence of jejunal morphological change, can confirm the diagnosis.

Patients should have pneumococcal vaccinations (because of splenic atrophy) once every 5 years