From the Guidelines
After testing positive for celiac antibodies, the next step is to consult with a gastroenterologist who will likely recommend an endoscopy with small intestinal biopsies to confirm the diagnosis, as stated in the guidelines for best practices in monitoring established coeliac disease in adult patients 1. This approach is crucial because not all commercial IgA-TG2 kits are of high quality, and alternative diagnoses may be more common and sometimes serious in adults with suspected celiac disease 1.
Key Considerations
- The treatment of celiac disease is a lifelong and strict gluten-free diet, which is necessary to relieve symptoms, achieve mucosal healing, avoid complications, and have a good quality of life 1.
- Follow-up testing typically occurs 6-12 months after diagnosis to ensure antibody levels are decreasing and intestinal healing is occurring 1.
- Additional testing may include bone density scans, nutritional deficiency screenings, and thyroid function tests, as celiac disease can cause malabsorption and is associated with other autoimmune conditions.
- Family members should also consider screening as celiac disease has a genetic component.
Importance of Expert Guidance
It is essential to work with a registered dietitian specializing in celiac disease to learn proper food selection, label reading, and cross-contamination prevention 1. The guidelines for best practices in monitoring established coeliac disease in adult patients, endorsed by the North American and European coeliac disease scientific societies, provide recommendations for best practices in monitoring patients with celiac disease based on the available evidence 1.
Next Steps
The primary treatment is a strict, lifelong gluten-free diet eliminating wheat, barley, and rye, and it is crucial not to start a gluten-free diet before the diagnostic procedure, as removing gluten prematurely can affect the accuracy of results 1. Regular follow-up with a healthcare team, including a physician and a dietician, is necessary to assess compliance with a gluten-free diet and to reinforce the importance of such compliance 1.
From the Research
Next Steps After Positive Antibodies for Celiacs
- After receiving a positive result for celiac disease antibodies, the next steps typically involve confirming the diagnosis and initiating treatment 2.
- Confirmation of the diagnosis is usually done through esophagogastroduodenoscopy with small bowel biopsy, although this may be avoided in certain cases, such as in children with high immunoglobulin A tissue transglutaminase levels and a positive test for immunoglobulin A endomysial antibodies 2.
- The primary treatment for celiac disease is a strict gluten-free diet for life, which can help to alleviate symptoms and prevent long-term complications such as osteoporosis and small bowel lymphoma 3, 2, 4.
- Patients may benefit from support groups and education on managing a gluten-free diet, including common and hidden sources of gluten, gluten-free substitutes, food labeling, and avoiding cross-contamination 2, 5.
- Regular monitoring and follow-up with a healthcare provider are essential to ensure adherence to the gluten-free diet and to address any potential complications or concerns 3, 5.
Gluten-Free Diet and Lifestyle
- A gluten-free diet should be based on a combination of naturally gluten-free foods and certified processed gluten-free products, and should be balanced to avoid nutrient deficiencies or excess 6.
- Patients with celiac disease should work with a registered dietitian nutritionist to develop a personalized meal plan and to ensure they are getting all the necessary nutrients 4.
- Social and emotional support are also important for individuals with celiac disease, as the condition can have a significant impact on daily life and social interactions 6, 5.
Ongoing Management and Monitoring
- Ongoing monitoring and management of celiac disease typically involve regular blood tests to check for antibodies and to assess the effectiveness of the gluten-free diet 3, 5.
- Patients should also be monitored for potential complications, such as osteoporosis and small bowel lymphoma, and should receive regular check-ups with their healthcare provider 3, 2.
- New technologies and therapies are being developed to improve the management and treatment of celiac disease, including alternative therapies and improved methods for monitoring adherence to the gluten-free diet 5.