Approach / Rationale
No scheduled review: patient is advised to return if symptomatic or unwell / Symptoms alert to potential problems (a reasonable statement) and lack of symptoms implies mucosal healing and dietary adherence
A time-based approach in which patients are scheduled for annual return visits / Such visits offer an opportunity for reassessment, reinforcement of the importance of the GFD, and blood tests to screen for complications, healing and adherence
This approach is recommended by the major gastroenterology bodies and by a systematic reviewS1–S3
Follow-up is based on mucosal healingS4 / Mucosal healing is the goal of therapy that leads to reduced risk of mortality and complications; no validated surrogate markers of healing
Annual intestinal biopsy identifies patient with suboptimal dietary adherence so they can be corrected at an early stage
This strategy has not reached consensus agreement and is not practical in some situations due to resource issuesS5
Abbreviation: GFD, gluten-free diet.
Supplementary Reference list
S1. Rubio-Tapia, A., Hill, I.D., Kelly, C.P., Calderwood, A.H. & Murray, J.A. ACG clinical guidelines: diagnosis and management of celiac disease. Am. J. Gastroenterol. 108, 656–676 (2013).
S2. Hill, P., Austin, A., Forsyth, J. & Holmes, G. British Society of Gastroenterology guidelines on the diagnosis and management of coeliac disease. Gut 64, 691–692 (2015).
S3. Haines, M.L., Anderson, R.P. & Gibson, P.R. Systematic review: The evidence base for long-term management of coeliac disease. Aliment. Pharmacol. Ther. 28, 1042–1066 (2008).
S4. Sharkey, L.M. etal. Optimising delivery of care in coeliac disease - comparison of the benefits of repeat biopsy and serological follow-up. Aliment. Pharmacol. Ther. 38, 1278–1291 (2013).
S5. Makharia, G.K. etal. Issues associated with the emergence of coeliac disease in the Asia-Pacific region: a working party report of the World Gastroenterology Organization and the Asian Pacific Association of Gastroenterology. J. Gastroenterol. Hepatol. 29, 666–677 (2014).
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