Enzyme Treatment for Celiac Disease Offers Promising News for the Future
Food is fundamental to human life. Beyond fuel for our bodies, it is a source of enjoyment, provides the basis of social interactions, and for many, is how we show love and share family history. Although eating gluten-free is rather fashionable at the present time, the reality of adhering to a strict gluten-free diet for patients of all ages diagnosed with celiac disease hits home when they realize this diet is for their entire life.
Celiac disease strictly limits the foods that a person can eat. Common ingredients like wheat, barley and rye send celiac patients’ digestive tracts into rebellion – gas, pain, diarrhea, fatigue, intestinal inflammation and weight loss are common. Currently, the only available management option is a life-long gluten-free diet. Given gluten’s prevalence, the diet represents a major lifestyle change for most people.
It’s a real burden. A recent study found that patients with celiac disease rate the burden of a gluten-free diet at or greater than the level experienced by patients who needed dialysis, insulin injections and other chronic medical treatments.
Considering all these issues, strategies beyond a gluten-free diet are needed.
Only a very limited number of experimental therapies for celiac disease have been tested in randomized, controlled clinical trials, which is the gold standard for research. So I was happy to see one of these trials published recently in the American Gastroenterological Association journal Gastroenterology.
It provided some promising news.
It found that an enzyme can reduce the “digestive rebellion” that a celiac patient on a gluten-free diet experiences after ingesting a small amount of gluten. This study is the first to find that a non-dietary intervention can potentially benefit celiac disease patients.
The potential of this therapy is significant given the ongoing exposure to low levels of gluten that cause distress and intestinal inflammation in celiac disease patients.
More studies need to be done before we know if this promising therapy will be available to patients. While I am optimistic about the future of non-diet therapy, I wonder about the cost and insurance issues that could come with a prescription drug.
In an era when patients are often asked to use over-the-counter treatments in lieu of more expensive prescriptions, it seems likely that insurance plans will consider the gluten-free diet an over-the-counter agent and access to prescription therapies could be (wrongly) curtailed.
Nonetheless, my patients and I look forward to the day when safe and effective therapies beyond a gluten-free diet are available to improve the health of those with celiac disease.
Sheila E. Crowe, MD, is a professor of medicine and director of research at UC San Diego School of Medicine. Dr. Crowe is an active member of the American Gastroenterological Association.