Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
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 NICE CKS. 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 NICE NG20.
- Monitoring for Nutritional Deficiencies: Assess for nutritional deficiencies, including iron, folic acid, calcium, and/or vitamin D, and determine if supplementation is needed NICE CKS. Full blood count and ferritin should be monitored annually to screen for anaemia and iron deficiency due to malabsorption and dietary changes NICE CKS. Specialist dietetic and nutritional advice should be considered NICE NG20.
- 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 NICE CKS,NICE NG20.
- 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 NICE CKS. Any other complications or associated conditions that may cause or contribute to ongoing symptoms should be assessed and managed NICE CKS.
- 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 NICE CKS.
- 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 NICE CKS,NICE NG20. Persistent or recurrent symptoms despite self-reported adherence should prompt assessment for inadvertent gluten exposure NICE CKS.
- Addressing Psychological Impact: Patients should be assessed for any associated depression, anxiety, and/or eating disorders, and these should be managed appropriately NICE CKS,NICE NG20.
- 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 NICE NG20. 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 NICE CKS,NICE NG20. Persistent or recurrent symptoms necessitate a review of the original diagnosis and confirmation of dietary adherence NICE CKS. Follow-up duodenal biopsy may be needed to rule out refractory disease or malignancy NICE CKS. Urgent 2-week referral should be arranged if malignancy or a serious complication is suspected NICE CKS.
- Information and Support: Provide advice on sources of information and support, such as national and local coeliac support groups NICE CKS,NICE NG20.