Management of coeliac disease

The management of coeliac disease involves a permanent gluten-free diet, and the vast majority of patients show a marked improvement following dietary change. As gluten is present in wheat, rye, barley and oats this imposes severe dietary restrictions on the patient, which must be fully explained. Rice and potatoes are satisfactory sources of complex carbohydrate.

Initially, frequent dietary counselling is required to make sure the diet is being observed, as the most common reason for failure to improve with dietary treatment is accidental or unrecognised gluten ingestion. In addition to diet, supportive therapy may include iron supplements, vitamin B12 and folic acid. In rare cases patients are refractory to standard treatment and require corticosteroids to induce remission.

Ideally, patients should undergo repeat jejunal biopsy after six months of gluten-free diet to ensure that the small bowel lesion has returned to normal, but this may not be necessary in the majority of patients in whom there is a dramatic clinical improvement.

Nursing priorities in coeliac disease relate to the planning and assessment of care which is focused upon nutritional impairment, diarrhoea and associated feelings of anxiety and embarrassment.

Evidence-based guidelines for the management of coeliac disease have been published by the British Society of Gastroenterology (BSG 2002).

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