The disease may be unmasked after partial gastrectomy. Jejunal biopsy can be performed even in small infants, but to obviate the risk of bowel perforation, only an experienced investigator should perform the test. Typical mucosal abnormalities appear in apparently healthy siblings of affected patients. Although gluten withdrawal has transformed the prognosis for children and substantially improved it for adults, some people still die of the disease, mainly adults who had severe disease at the outset. It is not known whether a gluten-free diet diminishes this risk.
Some patients can tolerate reintroduction of gluten into the diet after prolonged abstinence.
In any case, apparent clinical remission is often associated with histologic relapse that is detected only by review biopsies or by increased EMA titers. Treatment Gluten must be excluded from the diet. Ingesting even small amounts may prevent remission or induce relapse. Supplementary vitamins, minerals, and hematinics may be given, depending on deficiency. Mild cases may not require supplementation.