What complications should be monitored in patients (pts) with celiac disease?

From the Guidelines

Patients with celiac disease should be monitored for complications such as nutritional deficiencies, osteoporosis, malignancies, refractory celiac disease, and associated autoimmune conditions, with regular follow-up including assessment of symptom resolution, adherence to a gluten-free diet, and periodic blood tests, as recommended by the most recent guidelines 1.

Key Complications to Monitor

• Nutritional deficiencies, particularly iron, vitamin D, and metabolic parameters, as these are common in patients with celiac disease on a gluten-free diet 1
• Osteoporosis, with bone mineral density testing recommended in most adult patients after celiac disease diagnosis, especially when premenopausal or andropause age is approaching 1
• Malignancies, such as intestinal lymphoma and small bowel adenocarcinoma, which are increased in patients with celiac disease
• Refractory celiac disease and associated autoimmune conditions, which can occur in some patients with celiac disease

Monitoring Recommendations

• Regular monitoring of type 2 transglutaminase antibody (TG2Ab) titres to assess gluten exposure 1
• Evaluation by a specialist dietician to assess gluten-free diet adherence and nutritional quality 1
• Periodic blood tests to monitor for anemia, liver function abnormalities, and celiac antibody levels 1
• Repeat duodenal biopsy on a gluten-free diet may not be routinely necessary, but can be considered in patients with ongoing or alarming symptoms 1
• Video capsule endoscopy, enteroscopy, and assessment of T cell receptor clonality and lymphocyte aberrance by flow cytometry can be considered in patients with suspicions of celiac disease complications 1

Follow-up Schedule

• Patients should have follow-up visits 3-6 months after diagnosis and annually thereafter, with more frequent monitoring if complications are present or adherence to a gluten-free diet is poor, although the optimal frequency of controls is not established and may vary depending on regional organizations and available resources 1

From the Research

Complications of Celiac Disease

The following are potential complications that need to be monitored in patients with celiac disease:

• Anemia 2, 3, 4
• Iron deficiency 2
• Folic acid deficiency 2
• Vitamin B12 deficiency 2
• Osteoporosis 2, 3, 4
• Osteopenia 2
• Autoimmune diseases, such as:
  • Type 1 diabetes 3, 5, 6
  • Autoimmune thyroid disease 3, 5, 6
  • Sjögren's syndrome 3
• Malignancy 5
• Bone fractures 4
• Intestinal lymphoma 4
• Malabsorption of nutrients, including vitamin D 4
• Chronic fatigue 4
• Unexplained polyarthralgia 4

Monitoring and Screening

Regular monitoring and screening for these complications are essential in patients with celiac disease, especially those with a high risk of developing associated autoimmune diseases 6. Screening for celiac disease is also recommended in patients with autoimmune diseases, such as type 1 diabetes and autoimmune thyroid disease 5, 6. A gluten-free diet can help reduce the risk of complications and improve overall health 5, 6.