Celiac Disease: New Guidelines for Diagnosis and Management

David A. Johnson, MD

Disclosures

August 21, 2013

In This Article

Management of Celiac Disease

How is celiac disease managed?

These patients must be referred to a dietitian. That step is often missed. These people need dietary counseling because they are at high risk for vitamin deficiencies. Deficiencies in vitamin D (which leads to metabolic bone consequences), vitamin B12, and folate are common. Iron deficiency is often the protean manifestation of their disease. These people are subject to rare micronutrient deficiencies, such as copper, zinc, and carnitine. Working with a dietitian is very important.

Wheat, barley, and rye are the classic gluten proteins, but there are other foods that can pose problems. Oats are thought to be safe. Work with a dietitian and monitor this carefully as oats are introduced. Oats, at least in the United States, can be contaminated with other crops, so you have to be careful when foods containing oats are introduced into the diet and monitor these patients accordingly.

I invite you to read the ACG guidelines, and also to look back at a previous video commentary about gluten-free diets. This is not just about celiac disease. There are patients who respond to gluten-free diets -- some who are antibody-positive but biopsy-negative seem to respond more effectively to a gluten-free diet.

There was a very interesting article in Gastroenterology[2] that looked at the patients who were HLA-DQ2/8 positive and showed that irritable bowel patients responded to a gluten-free diet. A variety of patients, not just those with celiac disease, might respond to a gluten-free diet. Gluten-free foods are a $6 billion industry right now.

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