Follow-up of patients with celiac disease: Achieving compliance with treatment

https://doi.org/10.1053/j.gastro.2005.02.025Get rights and content

Celiac disease is the only autoimmune condition for which we know the environmental trigger: gluten. Complete removal of gluten from the diet in a patient with celiac disease should result in symptomatic, serologic, and histologic remission. However, compliance with the gluten-free diet, especially in the United States, is extremely challenging. Compliance can be measured both noninvasively, by dietary history and measurement of serum antibodies, and invasively, by using endoscopic and histologic criteria. The advantages and disadvantages of these various modalities are discussed. The highest rates of compliance are reported in patients who are diagnosed as young children, whereas adolescents and those diagnosed via mass serologic screening have the most transgressions. Barriers to compliance include the poor palatability of gluten-free foods, confusing food-labeling practices, and common comorbid psychologic burdens such as anxiety and depression. Because celiac disease is a multisystemic disorder, physicians need to be aware of the potential autoimmune, nutritional, and malignant complications. An algorithm for the follow-up and management of the newly diagnosed celiac disease patient is presented, which includes regular follow-up; measurement of serum antibodies; eliciting a detailed dietary history; and examination for signs and symptoms of nutritional deficiencies, malignancy, and other autoimmune diseases. Ideally, a team approach to the follow-up of the newly diagnosed patient should include regular supervision by an interested physician, medical nutritional counseling by a registered dietician, and access to local and national support groups knowledgeable about this condition.

References (62)

  • K. Kaukinen et al.

    Celiac disease in patients with severe liver diseasegluten-free diet may reverse hepatic failure

    Gastroenterology

    (2002)
  • S. Mora et al.

    A prospective, longitudinal study of the long-term effect of treatment on bone density in children with celiac disease

    J Pediatr

    (2001)
  • T. Kemppainen et al.

    Bone recovery after a gluten-free dieta 5-year follow-up study

    Bone

    (1999)
  • T. Kemppainen et al.

    Osteoporosis in adult patients with celiac disease

    Bone

    (1999)
  • A. Fasano et al.

    Zonulin, a newly discovered modulator of intestinal permeability, and its expression in coeliac disease

    Lancet

    (2000)
  • G.W. Meeuwisse

    Diagnostic criteria in coeliac disease

    Acta Paediatr Scand

    (1970)
  • Revised criteria for diagnosis of coeliac disease. Report of Working Group of European Society of Paediatric Gastroenterology and Nutrition

    Arch Dis Child

    (1990)
  • C. Ciacci et al.

    Long-term follow-up of celiac adults on gluten-free dietprevalence and correlates of intestinal damage

    Digestion

    (2002)
  • American Gastroenterological Association medical position statementceliac sprue

    Gastroenterology

    (2001)
  • J. Gonczi et al.

    A reliable screening test for coeliac diseaseenzyme-linked immunosorbent assay to detect anti-gliadin antibodies in serum

    Aust N Z J Med

    (1991)
  • P.G. Hill et al.

    IgA anti-gliadin antibodies in adult celiac disease

    Clin Chem

    (1991)
  • N. Rotolo et al.

    Importance of antigliadin antibodies determination during the follow-up of childhood coeliac disease

    Minerva Pediatr

    (1993)
  • E.H. Medeiros et al.

    Serum antigliadin antibodies in the diagnosis and follow-up of celiac disease

    Arquivos de Gastroenterologia

    (1994)
  • E.A. Valletta et al.

    Adherence to gluten-free diet and serum antigliadin antibodies in celiac disease

    Digestion

    (1990)
  • J. Rautonen et al.

    Antibodies to gliadin in children with coeliac disease

    Acta Paediatr Scand

    (1991)
  • R. Troncone et al.

    Antigliadin antibodies

    J Pediatr Gastroenterol Nutr

    (1991)
  • C. Sategna-Guidetti et al.

    Serum IgA antiendomysium antibody titres as a marker of intestinal involvement and diet compliance in adult celiac sprue

    J Clin Gastroenterol

    (1993)
  • M. Ferreira et al.

    Endomysial antibodyis it the best screening test for coeliac disease?

    Gut

    (1992)
  • C. Sategna-Guidetti et al.

    Reliability of immunological markers of coeliac sprue in the assessment of mucosal recovery after gluten withdrawal

    J Clin Gastroenterol

    (1996)
  • R. Troncone et al.

    Endomysial antibodies an unreliable marker for slight dietary transgression in adolescents with coeliac disease

    J Pediatr Gastroenterol Nutr

    (1995)
  • M.W. James et al.

    Endomysial antibody in the diagnosis and management of coeliac disease

    Postgrad Med J

    (2000)
  • Cited by (181)

    • Effect of gluten-free diet on metabolic control and anthropometric parameters in type 1 diabetes with subclinical celiac disease: A randomized controlled trial

      2020, Endocrine Practice
      Citation Excerpt :

      The tTG-IgA antibody takes longer to normalize on a GFD. Also, in patients with other autoimmune conditions, such as T1DM, these antibodies may remain elevated despite strict adherence to the diet and thus may not be useful to measure compliance in this subset of patients (25). The strength of the present study is that it is a RCT.

    • Celiac Disease

      2019, Mayo Clinic Proceedings
    View all citing articles on Scopus
    View full text