Dr. Schär Institute Logo

Coeliac disease

Different kinds of flour on wooden spoons

Treating coeliac disease means educating, caring for and motivating people

Anyone who wants to treat coeliac disease has only one option: the recommendation of a strictly gluten-free diet - for life. If this coeliac disease diet therapy is implemented consistently, sufferers can live symptom-free. In addition, the gluten-free diet reduces the risk of secondary diseases and associated conditions. To achieve this, comprehensive education, aftercare and motivation are recommended. Professional counselling from qualified dietitians or other nutritional professionals is particularly important here.

Why is information about coeliac disease therapy important?

After a diagnosis of coeliac disease, a strict gluten-free diet is required. As coeliac disease therapy must be followed for a lifetime, it makes sense to provide those affected with comprehensive information about its benefits. The first positive effects of the gluten-free diet can be seen after just a few weeks - and with consistent gluten-free diet therapy, sufferers can live symptom-free.

Advantages of gluten-free nutritional therapy:

  • Coeliac disease antibody findings normalise
  • The mucous membrane of the small intestine regenerates
  • Nutrients are reabsorbed and utilised
  • Weight loss is compensated
  • Health and physical wellbeing improves
  • Increased quality of life
  • Coeliac disease in children: Growth can normalise
  • Reduce sequelae and comorbidities

If those affected do not treat coeliac disease, secondary symptoms can occur - for example a lack of certain vitamins and trace elements, such as vitamin B12, calcium and iron. Non-compliance and nutritional deficiencies also increase the risk of possible comorbidities.

Possible comorbidities of coeliac disease are:

What follow-up care is part of coeliac disease therapy?

Regular follow-up checks are necessary to verify the consistent and correct implementation of the recommended therapy and to assess the success of these measures. The following aftercare management has proven successful in the context of coeliac disease therapy:

If the course of the disease is very stable in adulthood, check-ups can then take place every two years. These check-ups should record: the clinical course (including BMI and, in children, weight, length and puberty stages), adherence to the gluten-free diet, serology (tTG-IgA) and any complications.

If there are no symptoms and laboratory parameters are normalised, a routine control endoscopy should not be performed. A control endoscopy with duodenal biopsies should be performed if symptoms persist/recur or laboratory abnormalities appear (including persistence/recurrence of coeliac disease-specific antibodies) despite compliance with a strict gluten-free diet.

A control endoscopy can also be performed to exclude a secondary disease.

Successful coeliac disease therapy is also a question of motivation

As even traces of gluten can cause defects in the mucosa of the small intestine, coeliac patients should be supported accordingly. Advice from a trained nutritionist can be particularly helpful and motivating in this regard. This is because a wide variety of processed foods can contain traces of gluten, including sausage, spice preparations and sweets, for example.

How can adherence to a gluten-free diet be measured?

Various validated measurement tools are available to assess adherence to the gluten-free diet. These include the Celiac Disease Adherence Test (CDAT), the Gluten-Free Eating Assessment Tool (GF-EAT) and the Biagi score. The Coeliac Disease Food Attitudes and Behaviors Scale (CD-FAB) is also a measurement tool available at to assess the influence of a gluten-free diet on the attitudes, behaviour and quality of life of those affected.

However, adherence can also be checked by serological testing: All coeliac disease-associated antibodies are gluten-dependent. If a gluten-free diet is strictly adhered to, a decrease in the initial values can be expected within a few months. However, if the values do not fall and/or a positive serological test is carried out one year after the start of the gluten-free diet, this strongly indicates gluten contamination of the diet. IgG-TG2 titres (in patients with IgA deficiency) also decrease over time but may not normalise despite a strict gluten-free diet. However, a gluten-free diet can be expected to result in a significant decrease or even normalisation of malabsorption markers, such as steatorrhoea.

If patients are slow to respond to gluten-free diet therapy or if gluten contamination is suspected, specialist nutritional counselling can be helpful: a dietary review using questionnaires that evaluate reported adherence to the gluten-free diet and meal frequency is a useful tool to rule out accidental gluten intake and support a balanced and appropriate nutrient intake.

Which gluten-free products support the coeliac diet

Coeliac diet therapy is made easier by the wide range of special gluten-free products - from bread and pasta to flour mixes, biscuits and snacks. In many countries, the symbol of the "crossed-out ear of corn" guarantees gluten-free products. However, as the coeliac diet must be followed for life, the quality of gluten-free products also plays an important role.

Download clinical guides, patient resources, and other helpful materials for your practice here

Download now

Order free information sheets, product coupons and other useful resources for your patients here

Order now

Dr. Schär Institute Newsletter

Sharing GRD research and expertise for your practice: our newsletter keeps you up to date on coeliac disease and related topics.

Subscribe to the newsletter

This might also interest you

LEARN/Casuistics/first casuistry LEARN/Nutrition/Definition Gluten LEARN/ nutrition/quality/first lighthouse product

Case study: Concentration in decline – searching for clues in cases of unclear malabsorption

Read more

Gluten: definition, properties and nutritional significance

Read more

Sources

Previous chapter

Diagnosis