Celiac disease, sometimes called celiac sprue or gluten-sensitive enteropathy, is an immune reaction to eating gluten, a protein found in wheat, barley and rye.

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If you have celiac disease, eating gluten triggers an immune response in your small intestine. Over time, this reaction damages your small intestine's lining and prevents it from absorbing some nutrients (malabsorption).

In children, malabsorption can affect growth and development, besides causing the symptoms seen in adults.

There's no cure for celiac disease — but for most people, following a strict gluten-free diet can help manage symptoms and promote intestinal healing.

 

 

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Celiac disease

Celiac disease is a small bowel disorder characterized by mucosal inflammation, villous atrophy, and crypt hyperplasia, which occur upon exposure to dietary gluten and demonstrates improvement after withdrawal of gluten from the diet.

 

 

 

The intestinal damage often causes diarrhea, fatigue, weight loss, bloating and anemia.


In children, malabsorption can affect growth and development.

 

 

  • There's no cure for celiac disease — but for most people, following a strict gluten-free diet can help manage symptoms and promote intestinal healing.

     

  • Most patients with celiac disease also have lactose intolerance either temporarily or permanently and should avoid dairy products until the intestinal symptoms have improved on the gluten-free diet

  • Patients who have acute severe diarrhea with dehydration, electrolyte imbalance, and malnutrition may require total parenteral nutrition and intravenous or oral corticosteroids (prednisone 40 mg or budesonide 9 mg) for 2 or more weeks as a gluten-free diet is initiated

    Celiac disease should be differentiated from non-celiac gluten sensitivity in order to identify the risk for nutritional deficiency, complications of celiac disease, and to determine the necessary degree and duration of adherence to a gluten-free diet.

    The diagnosis of celiac disease also has important implications for family members who may be at risk for celiac disease and associated disorders.

     

Medications

  • Nutrient supplements in initial stages of therapy, as necessary

    • Folate

    • Iron

    • Zinc

    • Calcium

    • Vitamins A, B6, B12, D, and E

  • Calcium, vitamin D, and bisphosphonate therapy for osteoporosis

  • Corticosteroids or immunosuppression with azathioprine or cyclosporine may be helpful in patients with refractory celiac disease who do not have intestinal T cell lymphoma

 

 

 

Most people with pyelonephritis do not have complications if appropriately treated with bacteria-fighting medications called antibiotics.

In rare cases, pyelonephritis may cause permanent kidney scars, which can lead to chronic kidney disease, high blood pressure, and kidney failure. These problems usually occur in people with a structural problem in the urinary tract, kidney disease from other causes, or repeated episodes of pyelonephritis.

Infection in the kidneys may spread to the bloodstream—a serious condition called sepsis—though this is also uncommon.

 

 

Follow-Up

  • Improvement in symptoms within a few weeks on the gluten-free diet

Prognosis

  • Excellent prognosis with appropriate diagnosis and treatment

  • Celiac disease that is truly refractory to gluten withdrawal occurs in < 5% and carries a poor prognosis1

 

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You recently diagnosed a 30-year-old female with celiac disease. She is wondering what foods she should avoid. Which of the following foods DOES NOT contain gluten?

 


 

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