The Spectrum of Celiac Disease: Epidemiology, Clinical Aspects and Treatment

Greetje J. Tack; Wieke H. M. Verbeek; Marco W. J. Schreurs; Chris J. J. Mulder

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Treatment

The only currently available treatment for celiac disease consists in dietary exclusion of grains containing gluten and supportive nutritional care in case of iron, calcium and vitamin deficiencies.[63] A life-long gluten-free diet is a well tolerated therapy that improves health and quality of life in the vast majority of patients with celiac disease, even in those with minimal symptoms.[64] This treatment is, however, difficult to sustain, owing to small levels of gluten contamination in food products, high costs and restricted availability of gluten-free food alternatives, and cultural practices leading to a substantial social burden.[65] Therefore, in the past decade researchers have become increasingly interested in therapeutic alternatives for continuous or intermittent use in patients with celiac disease. Implementation of these is extremely challenging, as their potential adverse effects will always be difficult to accept as an alternative to a safe gluten-free diet.

Newly developed treatment modalities for celiac disease are aimed at reducing the need for a strict gluten-free diet and are based on currently available insights into the pathogenesis of the disease (Table 2). These therapies focus on alteration of dietary food products, decrease of gluten exposure by rapid enzymatic degradation, inhibition of small intestinal permeability or modulation of the immune response.[66] Clinical trials for some of these therapies are still ongoing. For the time being, strict adherence to a gluten-free diet should be advised for all patients with celiac disease, as it remains the only effective and safe therapy, which also seems to reduce the risk of complications.[67,68]

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