Principles and Strategies for Monitoring Individuals with Celiac Disease

Gluten-free diet is an effective therapy for celiac disease. There are few diseases in medicine where a nutritional intervention alone can produce such rapid, gratifying results. One may therefore question the need for following these patients long-term. In the past, a rather simplistic approach was taken towards treatment and follow-up of patients with celiac disease. “Go home, don’t eat anything with gluten and you’ll be fine”, patients were told. But as more individuals were diagnosed with celiac disease and our understanding of this disorder improved, several important issues emerged. Firstly, it was recognized that glutenfree diet is complex, costly and socially restrictive, and that cross contamination of the diet with gluten was very common. For a gluten-free diet to be fully effective, adherence to the diet must be strict and life-long, thereby adding further challenges. Gluten-free diet should be viewed as a “prescribed therapy” rather than a mere change in life style. Furthermore, celiac disease is not simply a malabsorptive gastrointestinal disorder. It is a multisystem, auto-immune disease that carries a significant health burden and risk of complications (Freeman et al. 2011). These factors necessitate ongoing, careful monitoring of patients with celiac disease. The following six key elements of management of celiac disease include longterm follow-up (NIH, 2004):