• Although not supported by data, many clinicians will check immunoglobulin A-tissue transglutaminase (IgA-tTG) titers every 3 months until normalized and then yearly as a rough test of diet adherence. In most patients, IgA-tTG titer should normalize within 6 to 9 months. [106]

  • Patients should be referred to a dietitian 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 normalization of IgA-tTG and mucosal healing. [107] Complete mucosal recovery takes varying amounts of time and less than half of celiac disease patients show normalization of duodenal histology after 1 year on the gluten-free diet, with adults being less likely than children to show mucosal healing. [108] Moreover, symptoms or lack of symptoms are poor predictors of mucosal inflammation or recovery. [109]

  • 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 normalized, repeat endoscopy is not routinely necessary.

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