Treatment of celiac disease

Treatment of celiac disease

The non-drug treatment is appropriate for many patients, and should be kept in consideration when opting for medical treatment. First, there must be a good doctor-patient relationship, since the disease is chronic and characterized by the presence of recurrent symptoms. Furthermore, the patient should be informed about the reasons for their symptoms and treatment options. The change in lifestyle should be taken into account, since stress and anxiety are the factors that trigger and maintain the intestinal symptoms. In this aspect, the physical exercises also have great value.

Attention to diet is important, and patients should avoid some types of foods, such as excess caffeine, fatty foods, and lactose (milk, cheese). In the case of lactose, 25% of patients with IBS may have an intolerance to this substance, and hence reduction of consumption can evolve with the improvement of symptoms in some cases. In patients with constipation, they should stimulate a high-fiber diet. In cases where there is abdominal distension due to intestinal gas, food such as beans, lentils, carrots, raisins, apricots, broccoli, cauliflower and onions should be avoided.

The use of fiber supplements is encouraged in IBS patients. During these cases, the feces become more viscous and lubricated, and bowel movements are more efficient, resulting in less traumatic evacuation. As for fiber options, water soluble ones are more effective than insoluble. Some studies show that fiber supplements are beneficial to patients with constipation, but can worsen symptoms in patients with diarrhea.

Psychotherapy is used in those patients in which emotional factors are strongly related to symptoms. In patients with diarrhea and abdominal pain, psychotherapy shows good results. Unfortunately, the same is not observed in patients with constipation.

Drug treatment of Irritable Bowel Syndrome includes measures that control symptoms related to constipation, diarrhea, and abdominal pain, as it comes to chronic disease and with no definitive cure. In patients with constipation, the treatment goal is to make the evacuation a no trauma event, which would reduce the abdominal pain and bloating, and consequent bloating. In cases of diarrhea, the goal is to reduce the defecation urgency and stool frequency.The treatment of constipation is the use of fibers and accelerate intestinal transit. In patients with diarrhea, it uses anti-diarrhea drugs. It should be remembered that these drugs should only be used after performing an accurate diagnosis of IBS and prescribed by a physician.

In cases of intestinal colic, the use of anti-spasmodic medication relaxes the bowel musculature, leading to a decrease in pain condition. However, it must be remembered that these medications are effective for abdominal pain, but have little effect in relation to diarrhea and constipation.

Some patients benefit from the use of antidepressants in low doses, probably due to the decrease in intestinal sensitivity. The use of antidepressants bring better results for patients with diarrhea, since one of the side effects of antidepressants is constipation. The use of antidepressants is mainly indicated in cases in which abdominal pain is prominent or when other therapies have failed.

Currently new drugs are being tested, especially agonists and antagonists of serotonin, which is a substance stimulating the intestinal function. However, these drugs may exhibit cardiovascular side effects, constipation, and severe ischemic colitis, their use is still very limited and controlled. With respect to flatulence, some studies have suggested the use of antibiotics to reduce the intestinal flora, which could be responsible for the formation of gas. However, it failed to prove that there is an increase of this flora in patients with IBS, and so this approach is not adopted by me in relation to patients.

How to diagnosis Celiac Disease?

The diagnosis is made based on the symptoms presented by the patient. In order to confirm the diagnosis, there should be no changes to the clinical examination or laboratory tests.

Generally, the doctor requests general blood and stool, and can detect the most common parasitic diseases.
These tests are not intended to confirm the diagnosis of Irritable Bowel Syndrome, but to rule out other causes of similar symptoms, as there is no test that can prove the diagnosis of IBS.

In individuals with the onset of these symptoms after age 40 and those with a family history of colon cancer, an evaluation by colonoscopy or, less frequently, barium enema with double contrast, is indicated to rule out this possibility.The presence of fever, bleeding, anemia, weight loss, symptoms overnight and large volume and frequency of diarrhea are not Irritable Bowel Syndrome characteristics and should trigger investigation of other causes.

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