Treatment

Currently all over the world the only treatment of CD is to depend upon the gluten free diet (GFD).GFD by the definition is any diet that doesn’t have gluten protein so in short avoid all aegilops ant triticum genus grain and their processed food. (Baranwal et al., 2003; world gastro. Org. Prac. 2007) some patient can ingest amount of gluten without developing symptoms while most of experience massive diarrhoea. Consuming gluten free food is tough decision for patients because selecting the food which doesn’t have gluten is quite miserable and rarely availability of food made only for CD patients. (TABLE) GFD in children and younger adult showed magnificent improvement in symptoms of CD .It not only improve abdominal and diarrhoea discomfort but behaviour of patient improved significantly while in child growth resumes. (Radlović et al., 2009) Intestinal villi finger like surface projection are reappear that are damaged by gluten in child while in adult patient there is partial regeneration of intestinal villi. CD show a wide spectrum symptoms like malabsorption of important vitamin and minerals that may cause iron deficient anemia or folic deficient anemia while in adult ones there is significant low blood calcium level that causes osteoporosis .So, while treating CD it is necessary one should have multivitamin tablets daily.

One of the different condition of CD that occur rare known as Refractory CD in which loss of intestinal villi occur and symptoms of CD do not improves despite of GFD . These cases are generally treated by medication with corcosteriods (Radlović et al., 2011) and immunosuppressive drugs.

Coadministration of several proteolytic enzymes with GFD may be the way to treat CD. Enzymes such as prolyl endopeptidases which are endoproteolytic enzymes expressed by both microorganisms and plants. Supplementation of the rat brush-border membrane with trace quantities of a bacterial prolyl endopeptidase led to the rapid destruction of immunodominant epitopes of these peptides.( Maiuri et al.,2001) Another study determined the efficiency of gluten degradation by a post-proline cutting enzyme, Aspergillus niger (AN)-PEP, in a dynamic system that closely mimics the human gastrointestinal tract (TIM system). AN-PEP is capable of accelerating gluten degradation in a gastrointestinal system that closely mimics in vivo digestion. This implies that coadministration of AN-PEP with a gluten-containing meal might eliminate gluten toxicity, thus offering patients the possibility of occasionally abandoning their strict gluten-free diet. (Mitea et al., 2008)

Therapeutic options such as administration of zonulin antagonist, tTg inhibitors, DQ2/DQ8 inhibitors. Therapy involves repeatedly injecting solutions of gluten at increasing concentrations. The aim is to desensitize the subjects slowly, in a way similar to allergy desensitization treatments. (Bethune et al., 2008) Other potential therapeutic options are based on use of the following antibodies(Zingone et al.,2010): (1) Anti-interferon γ antibody (fontolizumab)-down regulation of the TH1 mediated inflammatory response; (2) Human recombinant interleukin 10, (Tenovil)-interleukin-10 mediated expansion of type 1 regulatory T cells may suppress the immune response to gliadin; (3) Anti-CD3 antibody (visilizumab), anti-CD4 antibody (cMT412), anti-CD25 antibody (daclizumab) – gluten reactive T cells could be eliminated or made unresponsive by the administration of agents that alter the outcome of T cell activation; and (4) Anti-integrin α4 antibody (natalizumab), anti-integrin α4/β7 antibody (MLN-02), and integrin α4 antagonist (T-0047) - these inhibitors prevent leukocytes from migrating into inflamed tissues.

Table : Diet for celiac disease patient

Always avoid food

Barley Rye Wheat milk and other

dairy(most of CD patient are lactose intolerant)

Bulgur Durum flour Farina Graham flour Kamut Semolina Spelt

Allowed food

Amaranth Arrowroot Buckwheat Corn and cornmeal Flax Gluten-free flours (rice,

soy, corn, potato, bean)

Hominy (corn) Millet Quinoa Rice Sorghum Soy Tapioca Teff Beans, seeds, nuts in

their natural, unprocessed form

Fresh eggs Fresh meats, fish and

poultry (not breaded, batter-coated or marinated)

Fruits and vegetables Vitamins tablets

Under suspicion food

Oats (avoid oats at least during the initial treatment with a gluten-free diet)

Food additives Processed food beer breads Candy bars Canned soups Ice cream Instant coffee Ketchup and mustard Luncheon meats and

processed or canned meats

Pasta Salad dressings Yogurt Medications and

vitamins(use gluten as a binding agent)

Play dough

Refrences

Baranwal AK, Singhi SC, Thapa BR, Kakkar N. Celiac crisis. Indian J Pediatr. 2003; 70(5):433-5.

Radlovic N, Mladenovic M, Stojsic Z, Brdar R. Short-term corticosteroids for celiac crisis in infants. Indian Pediatr. 2011; 48(8):641-2.

Celiac disease. World Gastroenterology Organisation Practice Guidelines; 2007.

Radlović N, Mladenović M, Leković Z, Živanović D, Radlović V, Ristić D, et al. Effect of gluten-free diet on the growth and nutritional status of children with coeliac disease. Srp Arh Celok Lek. 2009; 137(11-12):632-7.

Maiuri L, Ciacci C, Vacca L, Ricciardelli I, Auricchio S, Quaratino S, Londei M. IL-15 drives the specific migration of CD94+ and TCR-gammadelta+ intraepithelial lymphocytes in organ cultures of treated celiac patients. Am J Gastroenterol 2001; 96: 150-156

Mitea C, Havenaar R, Drijfhout JW, Edens L, Dekking L, Koning F. Efficient degradation of gluten by a prolyl endoprotease in a gastrointestinal model: implications for coeliac disease. Gut 2008; 57: 25-32

Bethune MT, Borda JT, Ribka E, Liu MX, Phillippi- Falkenstein K, Jandacek RJ, Doxiadis GG, Gray GM, Khosla C, Sestak K. A non-human primate model for gluten sensitivity. PLoS One 2008; 3: e1614

Zingone F, Capone P, Fabiana CC. (2010) Celiac disease: Alternatives to a gluten free diet.World J Gastrointest Pharmacol Ther 1: 36-39