1. Indications and Use of the Gluten Contamination Elimination Diet for Patients with Non-Responsive Celiac Disease
- Author
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Pamela Cureton, Maureen M. Leonard, and Alessio Fasano
- Subjects
Disease status ,medicine.medical_specialty ,Glutens ,celiac ,Biopsy ,non-responsive ,lcsh:TX341-641 ,Disease ,Gastroenterology ,Article ,Antibodies ,Serology ,Diet, Gluten-Free ,03 medical and health sciences ,0302 clinical medicine ,Atrophy ,gluten-free diet ,celiac disease ,gluten ,refractory ,gluten contamination elimination ,Predictive Value of Tests ,Risk Factors ,Elimination diet ,Internal medicine ,Intestine, Small ,Humans ,Medicine ,Serologic Tests ,Treatment Failure ,030212 general & internal medicine ,Villous atrophy ,chemistry.chemical_classification ,Nutrition and Dietetics ,business.industry ,nutritional and metabolic diseases ,medicine.disease ,Gluten ,digestive system diseases ,chemistry ,Etiology ,030211 gastroenterology & hepatology ,business ,lcsh:Nutrition. Foods and food supply ,Food Science - Abstract
For the majority of patients diagnosed with celiac disease, once a gluten-free diet is initiated, symptoms improve within weeks and may completely resolve in months. However, up to 30% of patients may show signs, symptoms or persistent small intestinal damage after one year on a gluten-free diet. These patients require evaluation for other common GI etiologies and assessment of their celiac disease status in order to make a diagnosis and suggest treatment. Here, we propose an approach to evaluating patients with celiac disease with persistent symptoms, persistently elevated serology, and or persistent villous atrophy despite a gluten-free diet. We detail how to diagnose and distinguish between non-responsive and refractory celiac disease. Finally, we introduce the indications for use of the gluten contamination elimination diet and provide information for practitioners to implement the diet when necessary in their practice.
- Published
- 2017