World Digestive Health Day WDHD – May 29, 2016 ence to the diet varies and has been reported to range between 40-90%. The majority of the middle-class patients manage their diet without any problems. The diet is difficult for underprivileged patients. Pediatric data have shown that regular follow-up is associated with a significant increase in long-term compliance with GFD. Medical follow-up by gastroenterologists interested in CD is, in our opinion, essential for monitoring patients with CD to identify and prevent nutritional deficiencies, medical complications, and support adherence to GFD. However, the best way to follow up celiac patients has not yet been established. We do see the majority of our patients face-to-face every two years and in between by telephone within our setting of a dedicated celiac clinic (see Table 1). We hope to standardize this with celiac support groups and workings groups to assess the outcome and standardize the adherence to a GFD.42 REFERENCES 1. Tack GJ, Verbeek WH, Schreurs MW, Mulder CJ. The spectrum of celiac disease: epidemiology, clinical aspects and treatment. Nat Rev Gastroenterol Hepatol. 2010 Apr;7(4):204-13. 2. van Berge-Henegouwen GP, Mulder CJ . Pioneer in the gluten free diet: Willem-Karel Dicke 1905- 1962, over 50 years of gluten free diet. Gut. 1993 Nov;34(11):1473-5. 3. Wahab PJ, Meijer JW, Mulder CJ. Histologic followup of people with celiac disease on a gluten-free diet: slow and incomplete recovery. Am J Clin Pathol. 2002 Sep;118(3):459-63. 4. Nijeboer P, van Wanrooij RL, Tack GJ, Mulder CJ, Bouma G. Update on the diagnosis and management of refractory coeliac disease. Gastroenterol Res Pract. 2013;2013:518483. 5. Biagi F, Vattiato C, Agazzi S, Balduzzi D, Schiepatti A, Gobbi P, Corazza GR. A second duodenal biopsy is necessary in the follow-up of adult coeliac patients. Ann Med. 2014 Sep;46(6):430-3. 6. Makharia GK, Mulder CJ, Goh KL, Ahuja V, Bai JC, Catassi C, Green PH, Gupta SD, Lundin KE, Ramakrishna BS, Rawat R, Sharma H, Sood A, Watanabe C, Gibson PR; World Gastroenterology Organisation- MANAGING ADULT CELIAC DISEASE IN THE OUTPATIENT CLINIC, continued Table 1: Follow-up plan for patients with Celiac Disease in the VUmc AT DIAGNOSIS (PHYSICIAN AND DIETITIAN) • Complete physical examination • Education on celiac disease • Gluten-Free dietary counselling by a skilled dietician • Recommend family screening (DQ2/D8 and celiac serology) • Recommend membership in celiac support group • Bone Densitometry (not routinely recommended for children) • Celiac serology (if not previously obtained) • Routine Tests (complete blood count, iron studies, folate, thyroid function tests, liver enzymes, calcium, phosphate, vitamin D, and DQ2/8) AT 2-4 MONTHS (PHYSICIAN AND DIETITIAN) • Assess symptoms and coping skills • Dietary review AT 6 MONTHS (PHYSICIAN) (BY TELEPHONE) • Assess symptoms • Complete physical examination (on indication) • Dietary review • Celiac serology (tTgA) • Repeat Other Routine Tests (if previously abnormal) AT 12 MONTHS (PHYSICIAN AND DIETITIAN) • Assess symptoms • Abdominal physical examination (on indication) • Dietary review • Celiac serology (tTgA) • Repeat Other Routine Tests • Small intestinal biopsy (not routinely recommended for children) AT 24 MONTHS (PHYSICIAN) (BY TELEPHONE AS CLINICALLY INDICATED) • Assess symptoms • Dietary review • Celiac Serology • Thyroid function tests • Other Tests as clinically indicated • Dietitian as clinically indicated AT 36 MONTHS (PHYSICIAN) • Bone densitometry (if previously abnormal) • Assess symptoms • Dietary review • Celiac Serology • Thyroid function tests • Test as clinically indicated 38 WGO Handbook on DIET AND THE GUT World Digestive Health Day WDHD May 29, 2016
WGO Handbook on Diet and the Gut_2016_Final
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