Although not supported by data, many clinicians will check immunoglobulin A-tissue transglutaminase (IgA-tTG) titres every 3 months until normalised and then yearly as a rough test of diet adherence. In most patients, IgA-tTG titre should normalise within 6 to 9 months.
Patients should be referred to a dietician at diagnosis, and then have yearly check-ups to instruct and monitor gluten-free diet adherence.
Following the initiation of a gluten-free diet, there may be discordance between normalisation of IgA-tTG and mucosal healing. Complete mucosal recovery takes varying amounts of time and less than half of coeliac disease patients show normalisation of duodenal histology after 1 year on the gluten-free diet, with adults being less likely than children to show mucosal healing. Moreover, symptoms or lack of symptoms are poor predictors of mucosal inflammation or recovery.
Patients should be prescribed oral supplementation to treat any nutritional deficiencies present at diagnosis, and should be monitored until these deficiences are resolved.
If a patient is responding well clinically and IgA-tTG has normalised, repeat endoscopy is not routinely necessary.
Use of this content is subject to our disclaimer