Management of Celiac Disease

Initial Management

The American Gastroenterological Association recommends referring newly diagnosed patients to a dietitian for nutritional assessment and counseling about implementing a gluten-free diet 2
The American Academy of Family Physicians suggests testing for micronutrient deficiencies including iron, folate, vitamin D, and vitamin B12 in patients with celiac disease 2
The American Gastroenterological Association recommends determining bone mineral density to assess for osteoporosis in patients with celiac disease 1
The American Gastroenterological Association suggests treating identified nutritional deficiency states in patients with celiac disease 1

The American Academy of Family Physicians recommends strictly avoiding all products containing wheat, barley, and rye proteins for life in patients with celiac disease 2
The American Academy of Family Physicians suggests that pure oats may be safe for most patients with celiac disease, but should be introduced slowly with monitoring for adverse reactions 2
The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition recommends incorporating alternative gluten-free grains such as buckwheat, amaranth, quinoa, millet, and sorghum to improve nutritional profile in patients with celiac disease 3
The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition suggests focusing on home-made, natural gluten-free preparations including extra-virgin olive oil, milk, yogurt, plant foods, and fish rich in omega-3 fatty acids in patients with celiac disease 4

The American Gastroenterological Association recommends regular follow-up with healthcare team including physician and dietitian in patients with celiac disease 1
The American Academy of Family Physicians suggests using a combination of history and serology to monitor adherence to gluten-free diet in patients with celiac disease 2
The American Academy of Family Physicians recommends verifying normalization of clinical abnormalities detected on initial laboratory investigations in patients with celiac disease 2
The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition suggests considering using standardized patient-reported adherence questionnaires when expert dietitian is not available in patients with celiac disease 3

The American Gastroenterological Association recommends reviewing dietary history for inadvertent gluten ingestion in patients with persistent or recurrent symptoms despite gluten-free diet 6
The American Gastroenterological Association suggests checking serologic testing in patients with persistent or recurrent symptoms despite gluten-free diet 6
The American Gastroenterological Association recommends considering other conditions such as microscopic colitis, pancreatic exocrine insufficiency, bacterial overgrowth, and disaccharidase deficiency in patients with persistent or recurrent symptoms despite gluten-free diet 6

The American Gastroenterological Association recommends a gluten-free diet to protect against development of non-Hodgkin's lymphoma in patients with celiac disease 5
The American Gastroenterological Association suggests that a gluten-free diet can improve nutritional parameters in patients with celiac disease 5
The American Gastroenterological Association recommends a gluten-free diet to increase bone mineral density, with greatest improvements in first years of treatment in patients with celiac disease 5