an expert RD to carefully review their
diet, medications, and lipsticks or
other items that can be ingested.
After a period of adherence to a
GFD, celiac serological testing should
be repeated to verify that they have
normalized or are trending towards
improvement. These tests should be
repeated every three to six months
until they have completely normalized (refer to Figure 2).
that the serologic studies, other
abnormal laboratory studies, and
associated symptoms improve with
adherence to a gluten-free diet, there
is no specific recommendation to
repeat endoscopy with biopsy to confirm mucosal healing.
Health care maintenance of the
At diagnosis, a complete nutritional
assessment should be undertaken
as individuals with CD have high
rates of micronutrient deficiencies.
This assessment should include
vitamins A, D, E, K, cobalamin, and
folate, along with the micronutrients
copper, iron, selenium, and zinc.
Any deficiencies should be repleted
and repeat testing used to confirm
achievement of adequate levels. Since
vitamin D is not found in a normal
diet, this nutrient should be checked
on an annual basis. At diagnosis, and
periodically, bone densitometry test-
ing should be undertaken as individ-
uals with CD are at an increased risk
for diminished bone mineral density.
The British Society of Gastroenterology suggests that newly diagnosed
CD patients also receive pneumococcal and influenza vaccination.
Individuals with CD have a slight
increased lifetime risk of developing
small intestinal lymphoma of T-cell
origin and small intestinal adenocar-
cinoma. There are no guidelines for
screening practices for small intes-
tinal malignancy in individuals with
well-controlled CD since the risk is
low. However, individuals with re-
fractory celiac disease (RCD) have a
much higher risk for transformation
to a small intestinal T-cell lymphoma
and should be managed at a center
with expertise in CD. The complex
management of these patients goes
beyond the scope of this brief review.
Screening for celiac disease in
Screening of all first-degree relatives
of individuals with CD should be
considered regardless of symptoms
because of the high rates of disease
3 Refer to the section
on “Screening High-Risk Asymptomatic Individuals” for more details.
Approach to the celiac disease patient with recurrent symptoms
For most individuals with CD, adherence to a GFD results in rapid
Management of Newly
Diagnosed Celiac Disease
Individuals with CD have a slight increased lifetime
risk of developing small intestinal lymphoma of
T-cell origin and small intestinal adenocarcinoma.