Celiac Disease: After the Diagnosis

Celiac Disease (CD) Patient Management

Once a diagnosis of Celiac Disease has been confirmed through positive serology results, patient history, and clinical symptoms, adopting a gluten-free diet (GFD) is the best course of action for patients with CD.¹ Though this is currently the only available therapy for the management of CD, many patients struggle to transition from a regular diet to a GFD.

A GFD includes the removal of gluten containing foods, such as:

Wheat
Barley

Rye
Malt

Several well-established clinical guidelines can help facilitate the creation of a management plan that can then be personalized to meet that patient’s needs:

CD is associated with several long- term implications if left untreated, which can often be avoided with optimal management and timely diagnosis, including:^2-5

Central and peripheral nervous system disorders
Vitamin K deficiency associated with risk of hemorrhaging

Iron deficiency anemia
Early onset osteoporosis
Intestinal non-Hodgkin’s lymphomas

Pancreatic insufficiency
Gallbladder malfunction
Infertility

Poor, sometimes unintentional, adherence to a GFD can contribute greatly to persistent symptoms and increase the risk of the above various complications.⁶

It is recommended that patients who have a confirmed diagnosis of CD should be referred to a specialist or dietitian to receive nutritional assessment, monitor micronutrient deficiencies, and receive thorough education regarding a GFD. It is imperative that patients recognize the reality that a GFD is the only effective treatment recommended to safely prevent the mucosal damage caused by exposure to gluten. Adherence to the correct diet may result in the resolution of many symptoms and has the potential to repair intestinal damage over time in people with CD.⁷

If symptoms continue to manifest even after strict adherence to a GFD, it is recommended that patients undergo further diagnostic testing for associated or overlapping conditions.

There is a particularly strong connection between CD and autoimmune thyroid diseases (AITDs) which includes Hashimoto’s and Graves’ diseases.⁹ Symptoms of AITDs and CD often overlap, and up to half of patients newly diagnosed with CD also have an AITD.^8,9 Because these symptoms are ambiguous and overlapping, cross screening is rare.

Continued or worsening symptoms may point not only to disease progression but to other conditions and side effects associated with CD, such as:

Irritable Bowel Syndrome (IBS) - symptoms occur in up to 50% of patients¹⁰
Type 1 Diabetes - up to 16% of patients ^11,12
Infertility - up to 8% of women with unexplained fertility issues have CD and poor pregnancy outcomes¹³

Osteoporosis - up to one third of patients¹⁴
Addison’s disease - 5-12% of patients¹²
Sjögren’s Syndrome - prevalence in 4.5-15% of patients¹²

The presence of the above conditions should also trigger screening for CD in those who do not have a confirmed diagnosis, the same way the presence of CD should prompt screening of known comorbidities.

Patients with persistent or recurrent symptoms despite GFD require additional work-up to investigate the presence of disorders commonly associated with Non-Responsive Celiac Disease (NRCD). Consider follow-up testing if a patient continues to exhibit these symptoms:²

Persistent gastrointestinal symptoms
Persistent positive CD serology
Persistent villous atrophy
Presence of alarm signs and symptoms (i.e. anemia, fever, weight loss, persistent diarrhea)

Could your CD patient have an AITD?

Take me to thyroid testing >

Precise Management of Celiac Disease - A Tailored Approach for your Patients

It is recommended, that following diagnosis, people with CD should initially be followed-up in secondary care until they are progressing satisfactorily on a gluten-free diet.¹⁵The following symptoms in CD patients, or the worsening of overall quality of life, are clues that the plan may need to be re-evaluated:^15,16

Anemia
Fatigue
Joint problems
Depression

Weight Loss
Osteoporosis
Infertility
Miscarriage

Abdominal masses
Rectal bleeding
Development of other autoimmune diseases

Continued or worsening symptoms may indicate the presence of overlapping autoimmune diseases, which you can monitor through patient follow ups and cross screenings.

Continued Testing and Monitoring

Patients who have been tested, and subsequently diagnosed with one autoimmune disease are inherently more likely to develop additional, or related autoimmune conditions.¹⁷ You may want to consider screening your patients with CD for associated diseases.

Periodic monitoring of CD is recommended for the surveillance of new or residual symptoms in adherence with a gluten free diet, and special attention should be paid to children to ensure normal growth and development.⁷

The awareness and knowledge of coexisting or overlapping diseases can help you establish or refine the most appropriate management plan. If the patient’s condition seems to be deteriorating on their current management plan, cross screening and reevaluation may be necessary. There is universal agreement on the necessity of long term monitoring in CD to prevent complications and improve patient quality of life.⁷

Consider testing for associated disorders.

Take me to testing >

Conditions & Diseases

Understand allergic and autoimmune diseases.

Learn more

Tests

Diagnostic tests give reliable results that support primary care physicians as well as specialists in providing optimal patient management.