Professor Moshe (Erwin) SantoHead of the Institute for the Treatment of Digestive System and Liver Diseases
Celiac disease requires not just adherence to a diet, but a deep understanding of how the autoimmune process affects the entire body, and this approach is implemented at the Ichilov Clinic. Gastroenterologists with many years of experience in autoimmune diseases conduct comprehensive diagnostics that identify not only the degree of intestinal damage but also hidden deficiencies of vitamins, minerals, and the consequences of malabsorption for other organs. Treatment programs are based on personalized dietary protocols developed by clinical nutrition specialists, which take into account not only the exclusion of gluten but also the replenishment of formed deficiencies.
Interdisciplinary consultations involving immunologists, endocrinologists, and rheumatologists help identify accompanying autoimmune conditions that often accompany celiac disease and adjust therapy to prevent their development. Modern endoscopic technologies with video capsule examination allow for the assessment of the entire small intestine without discomfort, while control biopsies at certain intervals confirm the effectiveness of dietary changes.
About the Disease
Celiac disease is a chronic autoimmune disorder in which the consumption of gluten causes damage to the mucous membrane of the small intestine and disrupts nutrient absorption. The classical form manifests with pronounced gastrointestinal symptoms, the atypical form is characterized by extraintestinal manifestations, and the asymptomatic form occurs without clinical signs, while the refractory form does not respond to a gluten-free diet.
Causes
- Genetic predisposition with the presence of HLA-DQ2 or HLA-DQ8 genes
- Consumption of gluten from wheat, rye, barley
- Disruption of immune tolerance to gluten
- Family history of celiac disease
- Accompanying autoimmune diseases
Symptoms
- Chronic diarrhea or constipation
- Abdominal bloating and flatulence
- Weight loss and growth delay in children
- Anemia and vitamin deficiencies
- Chronic fatigue
- Abdominal pain
- Skin rashes (herpetiform dermatitis)
- Osteoporosis
- Infertility
- Neurological disorders
Treatment Methods
At the Ichilov Clinic, the choice of treatment methods for celiac disease is based on a thorough assessment of the degree of intestinal damage, the severity of symptoms, the presence of deficiencies, and accompanying autoimmune conditions, allowing for the creation of a personalized strategy for each patient.
Gluten-Free Diet Therapy
Immediately after confirming the diagnosis through serological tests and intestinal biopsy, a gluten-free diet becomes the foundation of treatment and the only way to stop autoimmune damage. Clinical dietitians at Ichilov develop individual nutrition plans that completely exclude wheat, rye, barley, and all products with their traces, while maintaining the completeness of the diet in terms of calories and nutrients. Regular monitoring using serological markers every three months shows the effectiveness of adherence to the diet and a decrease in antibody levels.
Nutrient Replacement Therapy
When damage to the intestinal villi has led to significant malabsorption, the body experiences a critical deficiency of vital substances that cannot be replenished through diet alone. Laboratory diagnostics at Ichilov include a comprehensive assessment of levels of iron, ferritin, B vitamins, folic acid, vitamin D, calcium, zinc, and magnesium to identify specific deficiencies. Replacement therapy protocols involve the use of high-dose medications in easily absorbable forms, often with parenteral administration in severe cases of anemia or osteoporosis. Specialized formulas with prebiotics and probiotics support the restoration of intestinal microbiota disrupted by prolonged inflammation.
Immunosuppressive Therapy
Refractory celiac disease, which does not respond to a strict gluten-free diet for a year and is accompanied by persistent symptoms and villous atrophy, requires suppression of excessive immune activity. Immunological examination reveals abnormal populations of intraepithelial lymphocytes that continue to damage the mucosa even in the absence of gluten in the diet. Systemic corticosteroids in gradually decreasing doses help reduce inflammation and allow the intestine to recover. In particularly severe cases, biological agents that block specific inflammatory molecules are used, allowing remission where standard therapy has proven ineffective.
Treatment of Accompanying Autoimmune Diseases
Celiac disease often coexists with other autoimmune conditions such as thyroiditis, type 1 diabetes, or rheumatoid arthritis, which requires a comprehensive interdisciplinary approach. Screening panels at Ichilov include testing for thyroid function, glucose levels, and antibodies to various tissues for early detection of accompanying pathology. Endocrinologists adjust hormonal therapy considering the impaired absorption of medications in the damaged intestine, increasing doses or switching to injectable forms. Rheumatologists adapt anti-inflammatory treatment in such a way as not to exacerbate the condition of the digestive tract. Coordination among specialists ensures a holistic approach, where the treatment of one disease does not worsen the course of another, and adherence to a gluten-free diet often leads to improved control over all autoimmune processes.
Diagnostic Methods for the Disease
Correct diagnosis of celiac disease is extremely important, as timely detection of the disease can prevent serious complications: autoimmune damage to the intestine, nutrient deficiencies, osteoporosis, infertility, and increased risk of oncology. At the Ichilov Clinic, diagnostics are performed on high-precision modern equipment (laboratory tests, HD endoscopy, histology), ensuring the accuracy of results. All procedures are planned in advance and performed within a short time – usually within 3 days.
First Day
Upon arrival at the clinic, the patient immediately sees the attending gastroenterologist. The doctor collects a detailed medical history (complaints, family history, dietary habits), conducts a thorough examination, and provides recommendations for necessary tests. This allows for a complete picture of the patient's condition and planning of the optimal diagnostic program.
Second Day
On the second day, a full range of tests is conducted for accurate confirmation of celiac disease.
- Complete blood count
- Biochemical blood analysis
- Test for antibodies to tissue transglutaminase (IgA tTG)
- Test for antibodies to endomysium (EMA)
- Test for antibodies to deamidated gliadin peptides (DGP)
- Total IgA level
- Serological study for HLA-DQ2/DQ8
- Esophagogastroduodenoscopy (EGDS) with biopsy of 6–8 fragments of the duodenal mucosa
- Histological examination of biopsies
Third Day
The attending physician gathers a consultation with the gastroenterologist, immunologist, and dietitian. This allows for the development of the most relevant and individualized treatment plan, including a strict gluten-free diet and monitoring measures.
How Much Does Treatment Cost in Israel
The cost of celiac disease treatment in Israel is determined by the volume of diagnostic procedures, including endoscopy with biopsy, genetic and serological testing, consultations with a gastroenterologist and dietitian, as well as replacement therapy programs for identified deficiencies. The final price depends on the stage of the disease, the presence of complications, and the need for an interdisciplinary approach. For an accurate cost estimate, you can contact the clinic consultant by phone, as indicated on the website.
Advantages of Treatment in Israel
- Gastroenterologists with many years of experience in managing autoimmune diseases and international certifications
- Comprehensive diagnostics with video capsule endoscopy and state-of-the-art genetic testing
- Personalized dietary therapy protocols developed by clinical nutritionists considering all deficiencies
- Interdisciplinary consultations involving immunologists, endocrinologists, and rheumatologists to identify accompanying conditions
- Comfortable accommodation conditions, with the option to use personal escort services
Even before arriving in Israel, patients can receive an online consultation with a specialized expert to discuss their case and preliminarily plan the examination. As a result of the video consultation, expert recommendations on current therapy, answers to all questions about the disease, and information about the clinic's modern diagnostic capabilities can be obtained.