Treatment Overview

The treatment for celiac disease is a strict gluten-free diet, which means:

• Avoiding all foods with wheat, barley, rye, triticale, or oats. Oats may later be gradually reintroduced into the diet.
• Not drinking beer unless it says it is gluten-free. Beers with and without alcohol, including lagers, ales, and stouts, contain gluten unless they specifically say they are gluten-free.
• Eating meals that include rice, corn, millet, and buckwheat.

Most people with the disease who adopt this diet permanently and consistently do not develop health problems associated with celiac disease. If nutritional deficiencies are present, other treatments may be needed, such as vitamin, iron, and calcium supplements.

Initial treatment

When celiac disease is diagnosed, you should immediately adopt a strict gluten-free diet. Eating even the smallest amount of gluten can cause symptoms such as weight loss and diarrhea. You may be advised to temporarily avoid milk or milk products until your intestine heals, at which time you may be able to gradually reintroduce them. A registered dietitian can help you learn how to incorporate this diet and its restrictions. Most people also find local and national celiac disease support groups helpful. For more information, see the Other Places to Get Help section of this topic.

Within 2 weeks after starting a gluten-free diet, most people with celiac disease find their symptoms improve. Symptoms should completely disappear within 3 months. But it takes 2 to 6 months or longer on a gluten-free diet for the tiny, finger-shaped, raised tissues (villi) of the small intestine to return to normal.

Celiac Disease: Eating a Gluten-Free Diet

Some children with untreated celiac disease become very sick and require hospitalization. Usually, they recover quickly after treatment with fluids and medicines. A gluten-free diet usually prevents these symptoms from returning.

Ongoing treatment

A gluten-free diet usually will eliminate symptoms of celiac disease and prevent long-term damage to the small intestine or other complications.

Symptoms of the disease are controlled by adopting a gluten-free diet, but you should see a doctor yearly for monitoring. A child especially needs to be watched for:

• Delayed growth. Children with celiac disease do not absorb needed nutrients if they eat gluten. This may result in delayed growth if gluten is eaten regularly over a long period. The vast majority of children catch up in growth unless diagnosis is delayed beyond puberty.
• Nutritional deficiencies. Eating gluten also can lead to an imbalance of chemicals, minerals, and vitamins. These deficiencies should reverse with a gluten-free diet, but vitamins, iron, or calcium supplements are sometimes needed.
• Tumors. As children who have celiac disease grow into adulthood, they may be at a slightly increased risk for developing cancer (lymphoma) in the small intestine and the esophagus, although the evidence for this is not clear. But studies have found that following a gluten-free diet lowers the risk for lymphoma.¹

Treatment if the condition gets worse

The most common cause of recurrent symptoms of celiac disease is eating foods containing gluten. In some people, eating even the smallest amount of gluten can cause symptoms of celiac disease, such as diarrhea and weight loss. Continuing to eat gluten causes inflammation and damage to the villi in the small intestine, regardless of whether symptoms are present. Nutrients may not be absorbed properly, which can lead to long-term complications, such as weak bones or growth problems (in children). Prolonged intestinal damage may increase the risk for developing severe complications, such as lymphoma.

If you or your child experiences symptoms or complications, you may need:

• A diet evaluation to ensure that it is gluten-free. Your doctor or registered dietitian can help you find out if you are eating foods with hidden gluten. Older children and teens may need to be reminded about the importance of staying with the diet.
• Testing for other diseases or conditions, such as irritable bowel syndrome, if no gluten is detected in your diet.
• Reevaluation of your original upper endoscopy and biopsy to ensure the accuracy of diagnosis.
• Oral steroids (in very rare cases). Experts disagree about using steroid medicines to treat people who have celiac disease and do not get better on a gluten-free diet. The American Gastroenterological Association recommends using injectable steroids to treat a sudden (acute), life-threatening attack of celiac symptoms. Oral steroids or other medicines that change the immune system response may be used to treat refractory sprue that doesn't respond to a gluten-free diet if other possible illnesses have been ruled out.

Treatment for complications varies depending on the specific problems and their severity. For example, some adults may require long-term treatment for complications, such as osteoporosis.

What To Think About

Sometimes a person who has celiac disease does not have symptoms after eating foods that contain gluten. But damage to the small intestine is still occurring. Such damage prevents the absorption of needed nutrients, which may cause complications such as growth delays in children. The damage to the small intestine can also cause an increased risk for lymphoma in the intestine.

Following a gluten-free diet can be challenging, especially for people who do not experience symptoms. Some teenagers find it extremely difficult to consistently avoid eating foods with gluten because it makes eating out with their friends difficult. You can help your teenager follow a gluten-free diet by continuing to emphasize its importance and thinking of ways to make it as easy as possible. If you are concerned about permanently staying on a gluten-free diet, talk with your doctor.