While classical gastrointestinal symptoms are widely recognized in Celiac Disease, many individuals present with subtle or non-specific features, which can delay diagnosis. This case study offers a unique perspective: a gastroenterology dietitian diagnosed with celiac disease, highlighting clinical, psychological and practical challenges, and reflecting on the implications for dietetic practice.

1. Patient Background and Referral

A 30 year old female gastroenterology dietitian working in an acute teaching hospital was identified with abnormal blood results during routine testing in primary care. She had no significant past medical history and was working full-time in a specialist dietitian role at the time of diagnosis.

2. Presenting History

Routine blood tests demonstrated low iron levels, prompting further investigation by the primary care physician, including celiac serology. Tissue transglutaminase IgA (tTG IgA) was significantly elevated. Prior to this, there had been no gastroenterology referrals or investigations.

The patient perceived herself to be largely asymptomatic. On retrospective reflection, symptoms included long standing fatigue and intermittent mild abdominal bloating and discomfort, previously attributed to the menstrual cycle. There was no reported altered bowel habits, significant pain, or weight loss. Symptoms were not severe or disruptive enough to prompt healthcare consultation.

3. Investigations and Diagnosis

An Oesophago-Gastro-Duodenoscopy (OGD) with duodenal biopsies was performed in February 2025. Histology demonstrated diffuse intraepithelial lymphocytosis, increased inflammatory infiltrate in the lamina propria, and one biopsy fragment suggestive of subtotal villous atrophy. In conjunction with markedly raised tTG IgA, a diagnosis of celiac disease was confirmed.

4. Anthropometry

• Weight: 105.8 lbs. (48 kg.) at time of diagnosis
• Height: 5 ft. 4.5 in. (1.64 m)
• Body mass index: 17.8 kg/m²

Weight had remained stable throughout adulthood, although there was a long-standing difficulty of gaining weight. Weight remained stable following diagnosis and dietary treatment.

5. Biochemistry

Initial blood tests demonstrated iron deficiency, reduced transferrin saturation, and low Vitamin B12, consistent with malabsorption. Celiac serology was markedly elevated (>250 U/mL) at diagnosis, with a progressive reduction over follow-up at 6 and 10 months. Improvements were also seen in iron biomarkers following dietary treatment and supplementation. Renal function and electrolytes remained normal throughout. These findings supported mucosal healing and dietary adherence, although some micronutrient levels declined following cessation of supplementation, reinforcing the need for ongoing monitoring.

6. Dietary Assessment

Prior to diagnosis, the patient followed no dietary restrictions and consumed a nutritionally varied diet. Following diagnosis, a strict gluten-free diet was implemented immediately. Despite professional expertise in managing celiac disease, the practical application proved challenging. Significant time was spent re-learning label reading, identifying hidden gluten sources, and addressing cross-contamination. Support resources, reputable online resources, and celiac support groups were used, demonstrating that professional knowledge does not remove the complexity of living with the condition.

8. Nutrition Intervention and Follow-Up

A strict gluten-free diet was maintained, supported by education, careful planning and use of specialized resources. Vitamin D, Vitamin B12 and iron supplementation was continued during the initial period of intestinal healing. Some supplements were later discontinued once biomarker improvement was demonstrated.

Dietary adherence remained strict. Weight was stable, celiac serology had reduced substantially, and micronutrient status had improved. Eating out and travel were maintained but required extensive planning. Repeat OGD biopsies after 1 year showed normal duodenum with no villous atrophy.