What follow-up strategies should I implement for patients diagnosed with Celiac disease to monitor for complications?

For patients diagnosed with coeliac disease, several follow-up strategies should be implemented to monitor for potential complications:

• Annual Review: Patients with confirmed coeliac disease should be reviewed at least annually in primary care ¹. This review should include measuring weight and height, reviewing symptoms, and considering the need for assessment of diet and adherence to the gluten-free diet ².
• Monitoring for Nutritional Deficiencies: Assess for nutritional deficiencies, including iron, folic acid, calcium, and/or vitamin D, and determine if supplementation is needed ¹. Full blood count and ferritin should be monitored annually to screen for anaemia and iron deficiency due to malabsorption and dietary changes ¹. Specialist dietetic and nutritional advice should be considered ².
• Assessing Bone Health: The person's risk of osteoporosis and the need for a dual-energy X-ray absorptiometry (DEXA) scan in adults should be assessed ¹,².
• Screening for Associated Conditions: Annual blood monitoring should include thyroid function tests to screen for associated autoimmune thyroid disease, and liver function tests to screen for associated autoimmune liver disease ¹. Any other complications or associated conditions that may cause or contribute to ongoing symptoms should be assessed and managed ¹.
• Monitoring Growth in Children: For children and adolescents, body weight, height, and body mass index (BMI) should be monitored to assess growth and nutritional status, as a satisfactory increase in weight and height is an essential marker of the success of the gluten-free diet ¹.
• Assessing Adherence to Gluten-Free Diet: Coeliac serology can be considered annually to help assess adherence to a gluten-free diet, although serology testing alone should not be used to determine adherence ¹,². Persistent or recurrent symptoms despite self-reported adherence should prompt assessment for inadvertent gluten exposure ¹.
• Addressing Psychological Impact: Patients should be assessed for any associated depression, anxiety, and/or eating disorders, and these should be managed appropriately ¹,².
• Specialist Referral for Persistent Issues or Complications: If concerns are raised during the annual review, the patient should be referred to a GP or consultant for further assessment ². Referral to a specialist is recommended if there is suspected non-responsive or refractory disease, or if there are persistent symptoms despite a gluten-free diet ¹,². Persistent or recurrent symptoms necessitate a review of the original diagnosis and confirmation of dietary adherence ¹. Follow-up duodenal biopsy may be needed to rule out refractory disease or malignancy ¹. Urgent 2-week referral should be arranged if malignancy or a serious complication is suspected ¹.
• Information and Support: Provide advice on sources of information and support, such as national and local coeliac support groups ¹,².