Table 2.

Monitoring of Individuals with Celiac Disease

Strength of Recommendation	Recommendation	Comment
Recommended for All Patients/Suggested by 5–6 of the 6 available Guidelines	Lifelong adherence to a GFD a,b,c,d,e,f Regular visit to celiac dietitiana,b,c,d,e,f Regular monitoring of gastrointestinal symptoms a,b,c,d,e Regular monitoring of GFD adherence a,b,c,d,e Regular monitoring of tTG a,b,c,d,e Regular laboratory testing of nutritional status a,c,d,e,f Bone density evaluation within 1 year of treatment a,c,d,e,f	While most guidelines suggest laboratory testing of nutritional status, specific recommendations vary greatly. Ferritin, vitamin B12, folate and 25- OH vitamin D are considered routine. Other tests to consider include zinc, calcium, copper, thiamin, albumin, vitamins B6, A, E and K
Consider in Most Patients/Suggested by 2–4 of the 6 available Guidelines	Regular visit with MD for celiac disease a,b,c,e Regular monitoring of anthropometrics b,c,d,e Referral to celiac advocacy groupa,b,c,f Regular monitoring of celiac related quality of lifec,d Regular monitoring of liver function tests c,e Regular monitoring of hemoglobinc,e Regular monitoring of lipid levels c,d	Routine celiac monitoring by a MD can be considered optional if the patient is followed by an expert celiac RD. Timing of follow up by RD or MD is variable but a common schedule is at diagnosis, 3–6 months post diagnosis for the first year or until in clinical remission and then annually thereafter
Not Routinely Necessary/Suggested in one of the 6 available Guidelines	Daily multivitamin and mineral supplement d Assessment for related autoimmune and endocrine disorders d Influenza and Pneumonia vaccination e Initial testing of prothrombin timec Regular monitoring of electrolytes and renal function d Repeat intestinal biopsy e	Most publications do not focus on nutritional therapy and although suggested in only the ADA guideline, recommendation of a multivitamin and calcium/vitamin D is common Vaccination recommended due to association of celiac disease with impaired spleen function

^aRecommended in the American Gastroenterology Association Technical Review on the diagnosis and management of Celiac Disease, 2006¹⁶

^bRecommended in the North American Society for Pediatric Gastroenterology,

Hepatology and Nutrition Guidelines for the diagnosis and treatment of celiac disease in children, 2005³⁶

^cRecommended in the National Institute of Health Consensus Report on Celiac Disease, 2004⁵⁸

^dRecommended in the American Dietetics Association Celiac Disease Evidence Based Nutrition Practice Guideline, 2009⁵⁷

^eRecommended in the Primary Care Society for Gastroenterology: The Management of Adults with Celiac Disease in Primary Care, 2006¹⁰⁴

^fRecommended in the World Gastroenterology Organization Practice Guideline for Celiac Disease, 2007¹⁰⁵