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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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At present the only effective management option for coeliac disease is a gluten-free diet.

  • gluten-free diet:
  • gluten is found in wheat, rye and barley but not in rice and maize
  • wheat flour is a particularly ubiquitous constituent of a modern diet with around 10-20 g of gluten in a typical daily diet, derived from multiple sources (e.g. - bread, breakfast cereals, pasta, pizza, pastry, biscuits, cakes and sauce)
  • the Codex standard now suggests that food containing less than 20 parts per million (ppm) of gluten can be labelled as ‘gluten free’ and that foods containing between 21-100 ppm of gluten can be labelled as ‘very low gluten’
  • fresh meat, fish, vegetables and fruit should form the core with rice or corn flour taking the place of wheat
  • oats - whether oats are toxic to patients with coeliac disease remains controversial
    • a review concerning the use of oats in coeliac disease concluded that, "...provided that safe oat products are available, the majority of coeliac disease and dermatitis herpetiformis patients prefer to consume oats; it is well tolerated and patients believe that this increment diversifies the diet "(1)
  • consult a dietician for the most suitable diet

Patients should receive counselling - to explain:

  • the disease
  • the normality of life on gluten free diet
  • the importance of dietary measures - elimination of risk of malignancy; normal growth in children
  • the value of follow up to monitor diet and compliance
  • importance of serological testing for first degree relatives

In addition patients should be encouraged to join Coeliac UK (who run regular group meetings and activities), or an equivalent association in their country (1)

  • coeliac UK publishes a book (directory), updated each year, listing gluten-free products and manufacturers

During clinic follow-up to:

  • check for symptoms
  • assess full blood count, folate and iron
  • manage associated problems, e.g. dermatitis herpetiformis
  • detect and manage complicationsserological testing for first degree relatives

Failure to respond treatment may be a result of:

  • dietary lapse
    • adherence to a strict gluten-free diet ranged from 42% to 91%,
    • good adherence were observed in patients who
      • followed-up with an expert dietitian
      • had membership of a coeliac disease advocacy group (2)
    • monitor anti-endomysial antibodies during follow ups
  • bacterial overgrowth of small bowel
  • exocrine pancreatic insufficiency
  • microscopic colitis
  • irritable bowel syndrome
  • associated lactose intolerance due to mucosal damage
  • refractory coeliac disease – require urgent evaluation by a gastroenterologist.
  • vitamin or mineral deficiency - Zn, Cu
  • development of malignancy – small bowel lymphoma or adenocarcinoma
  • incorrect original diagnosis (2)


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