Celiac disease medical therapy: Difference between revisions
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===Refractory disease=== | ===Refractory disease=== | ||
A minority of patients suffer from refractory disease, which means they do not improve on a [[gluten-free diet]]. This may be because the disease has been present for so long that the intestines are no longer able to heal on diet alone or the patient is not adhering to the diet, or the patient is consuming foods that contain [[gluten]]. Pharmacotherapy is used if dietary modification is not effective.<ref name="pmid20332526">{{cite journal |vauthors=Rubio-Tapia A, Murray JA |title=Classification and management of refractory coeliac disease |journal=Gut |volume=59 |issue=4 |pages=547–57 |year=2010 |pmid=20332526 |pmc=2861306 |doi=10.1136/gut.2009.195131 |url=}}</ref> | A minority of patients suffer from refractory disease, which means they do not improve on a [[gluten-free diet]]. This may be because the disease has been present for so long that the intestines are no longer able to heal on diet alone or the patient is not adhering to the diet, or the patient is consuming foods that contain [[gluten]]. Pharmacotherapy is used if dietary modification is not effective.<ref name="pmid20332526">{{cite journal |vauthors=Rubio-Tapia A, Murray JA |title=Classification and management of refractory coeliac disease |journal=Gut |volume=59 |issue=4 |pages=547–57 |year=2010 |pmid=20332526 |pmc=2861306 |doi=10.1136/gut.2009.195131 |url=}}</ref> | ||
* 1 '''Steroids''' | * 1. '''Steroids''' | ||
:::* Preferred regimen(1): [[Prednisone]] 0.5–1 mg/kg q24h | :::* Preferred regimen(1): [[Prednisone]] 0.5–1 mg/kg q24h | ||
:::* Preferred regimen(2): [[Budesonide]] 9 mg q24h | :::* Preferred regimen(2): [[Budesonide]] 9 mg q24h | ||
:::* Preferred regimen(3): [[Prednisone]] 0.5–1 mg/kg q24h and [[azathioprine]] 2 mg/kg q24h combination | :::* Preferred regimen(3): [[Prednisone]] 0.5–1 mg/kg q24h and [[azathioprine]] 2 mg/kg q24h combination | ||
* 2 ''' | * 2. '''Immunosuppressive drugs''' (Used in steroid dependent or steroid refractory disease) | ||
** 2.1 '''Antiproliferative agents''' | ** 2.1 '''Antiproliferative agents''' | ||
:::* Preferred regimen(1): [[Azathioprine]] 2 mg/kg q24h | :::* Preferred regimen(1): [[Azathioprine]] 2 mg/kg q24h | ||
Revision as of 15:26, 13 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]
Overview
A minority of patients suffer from refractory disease, which means that they do not improve with a gluten-free diet. Pharmocotherapy is used if alternative causes are eliminated and dietary modification is not beneficial. Pharmacotherapy include steroids, azathioprine, cyclosporin, and monoclonal antibodies.
Medical Therapy
Refractory disease
A minority of patients suffer from refractory disease, which means they do not improve on a gluten-free diet. This may be because the disease has been present for so long that the intestines are no longer able to heal on diet alone or the patient is not adhering to the diet, or the patient is consuming foods that contain gluten. Pharmacotherapy is used if dietary modification is not effective.[1]
- 1. Steroids
- Preferred regimen(1): Prednisone 0.5–1 mg/kg q24h
- Preferred regimen(2): Budesonide 9 mg q24h
- Preferred regimen(3): Prednisone 0.5–1 mg/kg q24h and azathioprine 2 mg/kg q24h combination
- 2. Immunosuppressive drugs (Used in steroid dependent or steroid refractory disease)
- 2.1 Antiproliferative agents
- Preferred regimen(1): Azathioprine 2 mg/kg q24h
- 2.2 Calcineurin Inhibitors:
- Preferred regimen(1): Cyclosporine 5 mg/kg q24h PO
- 2.3 Monoclonal antibodies
- Preferred regimen(1): Infliximab 5 mg/kg q24h
- Preferred regimen(2): Alemtuzumab 30 mg twice a week per 12 weeks
Dermatitis herpetiformis
- 1. Life style modification[2]
- 1.1 Gluten-free diet (GFD)
- 2. Pharmocatherapy[2]
- 2.1 Sulfones
- Preferred treatment(1):Dapsone 25-300 mg q24h
- 2.2 Suhphonamides
- Alternative treatment (1): Sulfapyridine 500 mg to 3 g q24h
References
- ↑ Rubio-Tapia A, Murray JA (2010). "Classification and management of refractory coeliac disease". Gut. 59 (4): 547–57. doi:10.1136/gut.2009.195131. PMC 2861306. PMID 20332526.
- ↑ 2.0 2.1 Collin P, Reunala T (2003). "Recognition and management of the cutaneous manifestations of celiac disease: a guide for dermatologists". Am J Clin Dermatol. 4 (1): 13–20. PMID 12477369.