Treatment & Follow-Up | Celiac Disease Foundation (2024)

The only treatment for celiac disease is to follow a strict gluten-free diet for life. This means avoiding foods and beverages that gluten, a protein found in wheat, rye, barley, and triticale (a hybrid of wheat and rye).

In the United States, products may be labeled gluten-free if they contain less than 20 parts per million (ppm) of gluten, and fortunately there is a wide variety of foods and beverages that are naturally gluten-free.

It is important to focus on what you caneat rather than what you cannot as a strict, gluten-free diet heals the villous atrophy in your small intestine caused by celiac disease, improving symptoms and decreasing your risk for long-term health complications.

Commonly, people with celiac disease are deficient in fiber, iron, calcium, magnesium, zinc, folate, niacin, riboflavin, vitamin B12, and vitamin D, as well as in calories and protein. Deficiencies in copper and vitamin B6 are also possible, but less common. Supplementation of B12 and folate may help individuals with celiac disease recover from anxiety and depression caused by vitamin deficiencies.

However, patients may continue to be vitamin B deficient as the gluten-free diet may not provide sufficient supplementation. This can be remedied with a daily,gluten-freemultivitamin. The multivitamin should not exceed100% of the daily value (DV)for vitamins and minerals. Calcium and vitamin D supplementation may also be prescribed by your physician if your intake is not sufficient.

One way to discover potential deficiencies is through testing, such as Proud Sponsor Labcorp OnDemand’s Vitamin Deficiency Test and Micronutrient Testfor patients ages 18+.

At Time of Diagnosis

At time of diagnosis, your physician should:

• Perform a complete physical exam including determination of BMI and examinations for enlarged lymph nodesandoccult blood in the stool
• For adults, and children with a long-delay in diagnosis, severe malabsorption or bone health isues, order bone densitometry
• Order celiac serology (anti-DGP IgA and anti-tTg IgA) and DQ2/DQ8 genetic testing, if not previously obtained
• Order routine tests (complete blood cell count, iron studies, vitamin B studies, thyroid functions tests with thyrotropin, liver enzymes, calcium, phosphate, 25-hydroxy vitamin D, copper, and zinc levels)
• Recommend family screening (DQ2/DQ8 genetic testing and celiac serology to include anti-tTg IgA, anti-DGP IgG, and total IgA to exlude IgA deficiency)
• Recommend a dietitian expert in celiac disease and the gluten-free diet to provide education and counseling
• Recommend a mental health professional to address the psychosocial aspects of going gluten-free and coping with a chronic disease, as needed
• Recommend a gluten-free multivitamin and additional supplementation as needed
• Assesshepatitis B, flu and pneumococcal immunization status

3-6 Month Visit

You shouldsee your physician 3-6months after your initial diagnosis and annually thereafter toidentify nutritional deficiencies, address symptoms you may still be experiencing, and confirm your adherence to the gluten-free diet. Patients on a strict gluten-free diet should have a negative anti-tTg IgA test at the 6-12 month mark. At the 3-6month visit, your physician should:

• Assess symptoms
• Perform a complete physical exam, on indication
• Order celiac serology (anti-DGP IgA and anti-tTg IgA)
• Repeat routine tests, if previously abnormal

12 Month Visit

At your 12 month visit, your anti-tTg IgA level should be as close to zero as possible. At this visit, your physician should:

• Assess symptoms
• Perform an abdominal physical examination, on indication
• Order celiac serology (anti-DGP IgA and anti-tTg IgA)
• Repeat routine tests
• Assess hepatitis B immunization status, if previously abnormal

Annual Thereafter

At your annual visit, yourphysician should:

• Assess symptoms
• Perform a complete physical exam
• Order celiac serology (anti-DGP IgA and anti-tTg IgA)
• Repeat routine tests
• Order other tests as clinically indicated
• Recommend a flu shot
• Recommend a dietitian to provide education and counseling as clinically indicated
• Recommend a mental health professional to address the psychosocial aspects of going gluten-free and coping with a chronic disease, as needed
• Repeat bone densitometry at 2-3 years, if previously abnormal, andfor adolescents non-compliant with a gluten-free diet
• For adults, consider repeat small intestinal biopsy at 3-5 years to assess dietary complianceand rule-out refractory celiac disease

At Time of Diagnosis

At time of diagnosis, your dietitianshould:

• Provide gluten-free dietary counseling, including education on the inclusion of oats, cross-contamination, andlabel-reading for foods, medications and supplements
• Review nutritional needs including age-appropriate calcium and vitamin D intake
• Recommend a gluten-free multivitamin

2–4 Week Visit

At your 2month visit, your dietitian should:

• Assess symptoms and coping skills
• Conduct a dietary review

6–12 Month Visit

At your 12month visit, your dietitian should:

• Assess symptoms and coping skills
• Conduct a dietary review

24 Month Visit

If you are still symptomatic or are struggling with the gluten-free diet, your physician may refer you to dietitian for additional counseling, education, and psychological support.¹At this visit, your dietitian should:

• Assess symptoms and coping skills
• Conduct a dietary review
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