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Individuals with celiac disease present with a wide array of symptoms and signs. Celiac disease can result in substantial
injury to the small intestine, deleterious effects on other organ systems, and an overall doubling of mortality. The role
of the gastroenterologist is primarily to make the diagnosis and then to ensure that patients with celiac disease receive
up-to-date and accurate instructions on diet. It is our opinion that gastroenterologists should participate in the follow-up
of what is in fact a form of inflammatory bowel disease. The failure to identify and treat patients with substantial problems
may result in an excess of preventable morbidity and mortality.
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Intestinal biopsy is the definitive method of making the diagnosis of celiac disease, provided the patient has not excluded
gluten from his or her diet, because exclusion of gluten results in negative serologic test results and normal small intestinal
biopsy samples.
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The removal of gluten from the diet can result in a total recovery of gut function and a correction of most other consequences.
The response is usually so complete that patients should consider themselves to be basically healthy as long as they stay
away from the offending foods. However, the execution and maintenance of the “theoretically simple” exclusion of gluten is
difficult. The condition is permanent and mandates adherence to a lifelong gluten-free diet; even small amounts of gluten
can result in injury to the intestinal lining. The diet is restrictive and requires the patient to be careful about food choices.
Therefore, patient education and motivation are crucial to a successful outcome.
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The correction of vitamin and mineral deficiencies may be helpful in aiding recovery; vitamin D and calcium supplementation
often is recommended.
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No drug therapy has been proven to suppress the disease.
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