Treatment and Follow Up

Celiac disease is a chronic autoimmune disease, which means that you cannot “grow out” of it. The treatment for both celiac disease and gluten sensitivity is lifelong adherence to a strict gluten-free diet.

Treatment

Lifelong Adherence to a Gluten-Free Diet

Celiac disease is a chronic autoimmune disease, which means that you cannot “grow out” of it. The treatment for both celiac disease and gluten sensitivity is lifelong adherence to a strict gluten-free diet. A gluten-free diet heals gluten-free-dietthe villous atrophy in the small intestine, causing symptoms to resolve. Following a gluten-free diet also helps prevent future complications, including malignancies.

Commonly, people with celiac disease experience iron, calcium and vitamin D deficiencies before adopting a gluten-free diet. Other common deficiencies include zinc, B6, B12, and folate. Your physician may order a bone density test at time of diagnosis and prescribe dietary supplements, including a gluten-free multivitamin, to correct this.  The multivitamin is usually prescribed because most gluten-free foods are not fortified.

Note: Medication is not normally required except in some cases of dermatitis herpetiformis, in which medication such as dapsone or sulfapyridine is administered for a short period of time to control the rash. In most individuals, following a strict gluten-free diet greatly reduces symptoms of dermatitis herpetiformis.

See our Live Gluten-Free section for an overview of the gluten-free diet as well as many other resources for your gluten-free lifestyle!


Follow Up

After diagnosis, you should meet with a dietitian/nutritionist experienced with a gluten-free diet. This is a critical and important step in understanding how to eat nutritious and safe foods for your body. You may also 11_celiac_disease_and_womens_healthwish to meet with a mental health professional or join a support group to help you address the psycho-social aspects of going gluten-free and coping with a chronic disease.

You should see your physician three to six months after diagnosis to identify nutritional deficiencies, address symptoms you may still be experiencing, and confirm your adherence to a strict gluten-free diet. Your physician will determine the timing of your follow-up appointments. Once it is confirmed that you are doing well, an annual physical examination with follow-up blood testing is recommended.  Antibody levels generally return to normal after 12 months on a gluten-free diet, although this can vary.

Do I Need a Repeat Endoscopy?

Some physicians recommend a repeat endoscopy and biopsy after 3-5 years on a gluten-free diet. Others feel that annual blood testing is sufficient if you are not experiencing any issues. Serum tTg-IgA antibodies are a good indicator of long-term dietary compliance, but not of short-term compliance.

Patients who are not doing well on a gluten-free diet may have additional biopsies to rule out refractory celiac disease. Refractory celiac disease, also known as refractory sprue, affects up to 5% of patients. For these patients, the damaged villi in the small intestine do not heal from a gluten-free diet, and all other potential causes for this damage have been ruled out. These patients are usually treated with steroids and immunosuppressants. Read more about common co-occuring conditions in people with celiac disease who don’t feel completely better on a gluten-free diet.


How Can I Find a Physician, Dietitian or Mental Health Professional Who Understands Celiac Disease and Gluten Sensitivity?

You can search for local health care practitioners familiar with celiac disease and gluten sensitivity in the CDF Healthcare Practitioner Directory.