Treatment

• Strict, lifelong gluten-free diet

  • Abstain from products containing wheat, rye, barley, or spelt.

  • Symptoms usually improve quickly [19]

• Recommended foods: rice, corn, potatoes, soybeans, millet

• Patients with secondary lactase deficiency: Avoid milk products.

• Iron and vitamin supplementation, if there are deficiencies (e.g., iron deficiency anemia) [15]

Managing celiac disease mainly consists of maintaining a lifelong gluten-free diet.

• Secondary lactase deficiency

• Moderately increased risk of malignancies

  • Enteropathy-associated T-cell lymphoma (EATL)

    • Origin: intraepithelial T cells

    • Localization: often proximal jejunum

    • Clinical presentation: initially often asymptomatic, but B symptoms and gastrointestinal symptoms may be present

  • Adenocarcinoma of the small bowel

  • Esophageal cancer [20]

• Refractory celiac disease (RCD): persistence and worsening of celiac symptoms despite strict adherence to gluten-free diet for 12 months

  • The condition manifests with one of three possible courses

    • Only partial improvement despite gluten-free diet

    • Initial improvement followed by relapse despite maintaining gluten-free diet

    • Nonresponsive celiac disease (no response to gluten-free diet)

  • May lead to ulcerative jejunitis

  • In severe cases, total parenteral nutrition and treatment with steroids or immunosuppressants may be necessary.

• There is no proven measure to prevent celiac disease.

• With infants, introducing small amounts of wheat (into the supplementary diet) between 4–6 months of age does not increase the risk of developing celiac disease