Management

Untreated disease may be fatal, but adequate and consequent antibiotic therapy often leads to complete remission. The systemic infection requires the use of antibiotic agents. However, treatment is based on empirical observations. A common antibiotic therapy starts with cephalosporine or meropenem (2 weeks intravenous), followed by cotrimoxazole orally for 1 year minimum. In the majority of cases this treatment results in a quick improvement of complaints. However, the disease may have a chronic relapsing course. In these cases changes in antibiotic treatment have to be considered. Second-line antibiotics include tetracycline, minocycline, or oral penicillin.[18] In therapy refractory cases the positive effects of immunosupportive treatment with interferon gamma have been described.[19] Additionally, general replacement therapy is necessary in many cases with malabsorption syndrome.

In patients responding to antibiotic treatment, control endoscopies and duodenal biopsies are recommended 6 and 12 months after diagnosis.[20] Treatment can be stopped after 1 year if the patients have no clinical signs and duodenal biopsy is no longer PAS positive.

Getting Started With Dumbbells

Getting Started With Dumbbells

The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.

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