Treatment & Follow-Up
Lifelong Adherence to the Gluten-Free Diet
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, and barley.
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 can eat 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.
Vitamins and Dietary Supplements
Commonly, people with celiac disease are deficient in key nutrients for health, including 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 certain nutrients may be necessary to avoid long-term complications associated with nutrient deficiencies.
Bone Health
Loss of bone mass due to malnutrition is common in celiac disease. For many patients, a physician may order a bone density test at time of diagnosis to assess bone density. Similarly, a bone density test may also be ordered for children and adolescents who have experienced severe malabsorption, a prolonged delay in diagnosis, have bone disease symptoms, or are non-compliant with the gluten-free diet.
Medication
At this time, the only treatment for celiac disease is the gluten-free diet. Medication may be prescribed if co-occurring conditions are present, such as thyroid disease or dermatitis herpetiformis. In most individuals, following a strict gluten-free diet greatly reduces symptoms of dermatitis herpetiformis.
Gluten may be found in the inactive ingredients of medications, but it is extremely rare. It is recommended that you check the ingredients in your medications to ensure that they do not contain gluten.
Physician Visits
At Time of Diagnosis
At time of diagnosis, your physician should:
- Perform a complete physical exam, including an assessment of growth or weight trends over time and signs of nutrient deficiencies.
- Order celiac serology (e.g., anti-DGP IgA and anti-tTG IgA), if not previously obtained.
- Recommend family screening (DQ2/DQ8 genetic testing and celiac serology, including anti-tTG IgA, anti-DGP IgG, and total IgA to exclude IgA deficiency).
- Assess hepatitis B, influenza, and pneumococcal vaccination status.
- Consider ordering a bone density scan.
- Order routine laboratory tests, including a complete blood count (CBC), iron studies, vitamin B studies, thyroid function tests (including TSH), liver enzymes, calcium, phosphate, 25-hydroxy vitamin D, and zinc levels.
- Refer to a registered dietitian with expertise in celiac disease and the gluten-free diet for education and counseling.
- Recommend a gluten-free multivitamin and additional supplementation as needed.
- Refer to a mental health professional, as appropriate, to support coping with a chronic disease, navigating the psychosocial challenges of a gluten-free diet, and addressing barriers such as food access or food insecurity.
Follow-Up Visits
You should see your physician 3-6 months after your initial diagnosis and annually thereafter. At follow up visits, your physician should:
- Assess symptoms at each visit.
- Order celiac serology (e.g., anti-DGP IgA and anti-tTG IgA) if not previously obtained. DQ2/DQ8 genetic testing may be indicated based on the clinical presentation.
- Assess hepatitis B immunization status at the 12-month visit if previously abnormal.
- Recommend an annual influenza vaccination.
- Refer to a mental health professional, as appropriate, to support coping with a chronic disease, navigating the psychosocial challenges of a gluten-free diet, and addressing barriers such as food access or food insecurity.
- Consider a repeat small intestinal biopsy 1–3 years after diagnosis to assess intestinal healing and rule out refractory celiac disease.
- Perform a complete physical exam as clinically indicated at the 3–6-month visit and annually thereafter.
- Refer to a registered dietitian for education and counseling as clinically indicated.
- Repeat a bone density scan 2–3 years after diagnosis if previous results were abnormal.
Dietitian Visits
At Time of Diagnosis
At time of diagnosis, your dietitian should:
- Evaluate clinical status, symptom course, and relevant biochemical markers to assess nutritional status, disease control, and potential complications.
- Document food and nutrition intake by obtaining a comprehensive diet history.
- Assess prescribed and over-the-counter medications and supplements for potential gluten content, as well as possible food–drug and drug–drug interactions.
- Assess the patient’s understanding of the gluten-free diet, ability to implement dietary recommendations, relationship with food, and coping with the demands of the diet.
- Provide clear, individualized education on the gluten-free diet.
Collaborate with physicians, mental health professionals, and other members of the healthcare team as indicated. - Assess gastrointestinal and extraintestinal manifestations of celiac disease.
- Evaluate factors that may affect quality of life, including the impact of the gluten-free diet on social situations, cultural and religious practices, travel, finances, and food access.
Follow-Up Visits
Follow-up visits should occur at a timeframe mutually agreed upon between you and your dietitian. Most people will have multiple follow up visits. At these visits, your dietitian should:
- Re-evaluate clinical status, symptom course, and relevant biochemical markers to assess nutritional status, disease control, and potential complications.
- Document food and nutrition intake by obtaining a comprehensive diet history.
- Reassess prescribed and over-the-counter medications and supplements for potential gluten content, as well as possible food–drug and drug–drug interactions.
- Reassess the patient’s understanding of the gluten-free diet, ability to implement dietary recommendations, relationship with food, and coping with the demands of the diet.
- Adjust the gluten-free diet plan as clinically indicated.
- Collaborate with physicians, mental health professionals, and other members of the healthcare team as indicated.
- Reassess gastrointestinal and extraintestinal manifestations of celiac disease.
- Re-evaluate factors that may affect quality of life, including the impact of the gluten-free diet on social situations, cultural and religious practices, travel, finances, and food access.