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Follow-up of patients with celiac disease: achieving compliance with treatment.

Abstract

Celiac disease is the only autoimmune condition for which we know the environmental trigger: gluten. Complete removal of gluten from the diet in a patient with celiac disease should result in symptomatic, serologic, and histologic remission. However, compliance with the gluten-free diet, especially in the United States, is extremely challenging. Compliance can be measured both noninvasively, by dietary history and measurement of serum antibodies, and invasively, by using endoscopic and histologic criteria. The advantages and disadvantages of these various modalities are discussed. The highest rates of compliance are reported in patients who are diagnosed as young children, whereas adolescents and those diagnosed via mass serologic screening have the most transgressions. Barriers to compliance include the poor palatability of gluten-free foods, confusing food-labeling practices, and common comorbid psychologic burdens such as anxiety and depression. Because celiac disease is a multisystemic disorder, physicians need to be aware of the potential autoimmune, nutritional, and malignant complications. An algorithm for the follow-up and management of the newly diagnosed celiac disease patient is presented, which includes regular follow-up; measurement of serum antibodies; eliciting a detailed dietary history; and examination for signs and symptoms of nutritional deficiencies, malignancy, and other autoimmune diseases. Ideally, a team approach to the follow-up of the newly diagnosed patient should include regular supervision by an interested physician, medical nutritional counseling by a registered dietician, and access to local and national support groups knowledgeable about this condition.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    Division of Gastroenterology, Childrens Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA. mpietzak@chla.usc.edu

    Source

    Gastroenterology 128:4 Suppl 1 2005 Apr pg S135-41

    MeSH

    Adolescent
    Adult
    Algorithms
    Autoimmune Diseases
    Celiac Disease
    Child
    Child, Preschool
    Glutens
    Humans
    Infant
    Medical History Taking
    Nutrition Disorders
    Nutritional Status
    Patient Care Planning
    Patient Compliance
    Serologic Tests
    Social Support

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    15825121

    Citation

    Pietzak, Michelle Maria. "Follow-up of Patients With Celiac Disease: Achieving Compliance With Treatment." Gastroenterology, vol. 128, no. 4 Suppl 1, 2005, pp. S135-41.
    Pietzak MM. Follow-up of patients with celiac disease: achieving compliance with treatment. Gastroenterology. 2005;128(4 Suppl 1):S135-41.
    Pietzak, M. M. (2005). Follow-up of patients with celiac disease: achieving compliance with treatment. Gastroenterology, 128(4 Suppl 1), pp. S135-41.
    Pietzak MM. Follow-up of Patients With Celiac Disease: Achieving Compliance With Treatment. Gastroenterology. 2005;128(4 Suppl 1):S135-41. PubMed PMID: 15825121.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Follow-up of patients with celiac disease: achieving compliance with treatment. A1 - Pietzak,Michelle Maria, PY - 2005/4/13/pubmed PY - 2005/5/6/medline PY - 2005/4/13/entrez SP - S135 EP - 41 JF - Gastroenterology JO - Gastroenterology VL - 128 IS - 4 Suppl 1 N2 - Celiac disease is the only autoimmune condition for which we know the environmental trigger: gluten. Complete removal of gluten from the diet in a patient with celiac disease should result in symptomatic, serologic, and histologic remission. However, compliance with the gluten-free diet, especially in the United States, is extremely challenging. Compliance can be measured both noninvasively, by dietary history and measurement of serum antibodies, and invasively, by using endoscopic and histologic criteria. The advantages and disadvantages of these various modalities are discussed. The highest rates of compliance are reported in patients who are diagnosed as young children, whereas adolescents and those diagnosed via mass serologic screening have the most transgressions. Barriers to compliance include the poor palatability of gluten-free foods, confusing food-labeling practices, and common comorbid psychologic burdens such as anxiety and depression. Because celiac disease is a multisystemic disorder, physicians need to be aware of the potential autoimmune, nutritional, and malignant complications. An algorithm for the follow-up and management of the newly diagnosed celiac disease patient is presented, which includes regular follow-up; measurement of serum antibodies; eliciting a detailed dietary history; and examination for signs and symptoms of nutritional deficiencies, malignancy, and other autoimmune diseases. Ideally, a team approach to the follow-up of the newly diagnosed patient should include regular supervision by an interested physician, medical nutritional counseling by a registered dietician, and access to local and national support groups knowledgeable about this condition. SN - 0016-5085 UR - https://www.unboundmedicine.com/medline/citation/15825121/Follow_up_of_patients_with_celiac_disease:_achieving_compliance_with_treatment_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016508505001940 DB - PRIME DP - Unbound Medicine ER -