Are follow-ups necessary with celiac disease?

Follow-ups are recommended in order to avoid nutritional deficiencies or complications or to check compliance with the diet (this indicates how well the patient is sticking to the diet plan). In principle, follow-up examinations are recommended at 3 months and 1 year after the diagnosis. After that, the following examinations are recommended once a year (lifelong):
• Clinical examination: weight, height, BMI, puberty status (children), general well-being
• Laboratory examinations: blood antibody analysis and further examinations depending on the symptoms
• Nutrition counseling

Biopsies are recommended if there is uncomplicated development and when the patient was diagnosed after the age of three.
If there are no doubts regarding the diagnosis, it is unreasonable to do a further biopsy of the small intestine to see whether the mucous membrane has normalized itself. We do, however, recommend regular medical examinations to check laboratory values, especially the following:
• Iron levels (blood count, iron, ferritin). A persistent lack of iron can be compensated with oral iron supplements.
• Anti–TTG antibodies (positive results indicate that the gluten-free diet was not followed strictly enough)
• Examinations for early detection of existing or possible autoimmune diseases.

A bone density measurement to check for osteoporosis is especially necessary for females who were diagnosed with celiac disease late. Should notable weight gain be ascertained between checkups, we recommend first-degree metabolic examinations (total cholesterol, HDL cholesterol, triglycerides, glucose). Close relatives of people with celiac disease (children, brothers/sisters, parents) have a higher predisposition to celiac disease (about 10 %) than the general population. It is therefore recommended that immediate relatives do a serological analysis or undergo HLA-DQ2 and HLA-DQ8 genotyping. The genotype shows whether the subject has a genetic predisposition to celiac disease or not.