Case study: Nutritional Management of a Patient with Newly Diagnosed Coeliac Disease
Brief description
The patient was a woman in her late 30s referred to a telephone outpatient dietetic clinic following a new diagnosis of coeliac disease. She had previously been well with no significant gastrointestinal history. Referral was made by the gastroenterology team after positive serology and confirmatory biopsy. This patient had attended our group session on how to follow a gluten free diet for Coeliac disease and was now booked in for a one-to-one telephone appointment to consolidate her knowledge and offer more tailored support to assist with the implementation of a strict gluten free diet.
Case presentation
1. Presenting Complaint / History of Presenting Issue
The patient initially developed gastroenteritis whilst on holiday abroad. Although the acute infection resolved, she continued to experience persistent gastrointestinal symptoms. These included frequent loose stools, abdominal discomfort, and significant abdominal bloating. She also reported reduced appetite and unintentional weight loss.
Symptoms persisted for several weeks following the infection and began to impact her quality of life, including reduced dietary intake. Following a GP appointment, she was referred to gastroenterology where she was diagnosed with coeliac disease.
2. Medical History & Medications
The patient had no significant past medical history and was otherwise fit and well. Current diagnosis: Coeliac disease Medications/Supplements: OTC Multivitamin and Vitamin D supplements.
3. Anthropometry
- Height: 1.6 m
- Pre-illness weight: 60 kg
- Weight at dietetic assessment: 55 kg
- BMI: 21.5 kg/m²
This represented an approximate 5 kg (8.3%) unintentional weight loss over three and a half months. The weight loss was likely related to malabsorption upon accidental gluten intake and reduced oral intake due to ongoing gastrointestinal symptoms.
4. Biochemistry
At diagnosis, investigations demonstrated:
- Positive tissue transglutaminase antibodies (tTG)
- Confirmatory duodenal biopsies.
- Low ferritin consistent with iron deficiency
- Borderline vitamin D levels
- Slightly reduced PTH levels.
These findings were consistent with active coeliac disease and associated micronutrient malabsorption.
5. Dietary Assessment
A 24hr diet recall was taken during our consultation. At this point the patient had received some information of following a gluten free diet from the group session.
It was as follows:
- Breakfast - Homemade GF granola with greek yoghurt or porridge oats.
- Lunch - Tinned soup +/- a slice of GF toast OR chicken/egg mayo sandwich with Schar seeded loaf bread.
- Dinner - generally a protein source (meat/chicken) with a side of potatoes or rice and mixed vegetables - half portion. Yoghurt or jelly for puddings on occasion.
- Snacks - rice crackers, GF biscuits.
- Fluids - x8 cups of tea (250ml) with a splash of milk, water occasionally throughout the day ~2 cups/day.
The patient demonstrated some knowledge of gluten sources but was not aware of various possible cross-contamination risks. She was confident around food labels and safe food choices when dining out. Since diagnosis, she had started trialling gluten free products and reported enjoying gluten free alternatives.
6. Psychosocial Factors
The patient lived with her partner who was supportive of the dietary changes required. She reported having access to gluten free foods via her local supermarkets but mentioned many of these food items came with a higher price tag compared to non-gluten free food. She was highly motivated to adhere to dietary advice due to the clear link between gluten consumption and symptoms - she had already started to implement these dietary changes before our consultation.
7. Dietetic Intervention
Dietetic intervention focused on education and practical support for long-term adherence to a gluten free diet. This was done via a virtual group session and via a one to one telephone consultation.
Key areas covered included:
- Knowledge re: foods containing gluten (wheat, barley, oats and rye)
- Naturally gluten free alternatives e.g., was unsure of polenta being naturally gluten free.
- Label reading and identifying hidden gluten sources e.g., was not aware that regular gravy could be a gluten source.
- Preventing cross-contamination in the home environment and when dining out. The patient was also provided with information regarding online/app resources to support their dining out whilst on holiday (mygfguide blog and findmeglutenfree app).
- Tips to ensure regular bowel motions and ensure good hydration e.g., incorporating more mineral water intake during the day via cups of water, squash etc.
Nutritional advice was also provided to address potential deficiencies, including increasing iron-rich foods alongside vitamin C sources and optimising calcium intake (low intake as indicated by diet and PTH levels). Vitamin D supplementation was recommended in line with UK guidance. Educational resources were provided (BDA Coeliac disease and Calcium factsheets), including information about support available through Coeliac UK.
8. Outcome / Follow-Up Review
At six-month follow-up, the patient reported significant improvement. Gastrointestinal symptoms had completely resolved, with normal stool frequency and no further abdominal discomfort or bloating. The patient’s appetite had improved and her weight had begun to stabilise. She reported strong adherence to the gluten free diet and increased confidence with food choices and label reading. Repeat blood tests for micronutrient status were planned through her GP at a later stage to monitor improvement.
9. Reflection
This case highlighted the importance of combining group education with one-to-one support to address gaps in knowledge and promote long-term adherence to a gluten free diet. It reinforced the need to consider both symptom management and micronutrient deficiencies. The positive outcome demonstrated the impact of tailored dietetic intervention on improving symptoms and patient confidence.
Author
Arafah Olusekun RD,
Band 5 Dietitian
Wythenshawe hospital, Manchester
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