Laboratory/ Diagnostic Testing

  • Serology (Tissue transglutaminase, deamidated gliadin peptide can be used for monitoring CD)
  • CBC
  • LFTs
  • Vitamins & Minerals- A, D, E, B12, folic acid, copper, zinc, ferritin, iron, calcium (may consider adding vitamin K, vitamin B6, magnesium, and selenium)
  • Presence of HLA-DQ2 or HLA-DQ8 genotyping (may be used if CD diagnosis is unclear)

 


Medication Management (including vitamins & minerals)

  • Vitamin B complex
  • Supplemental vitamin D based on vitamin D level
  • Calcium intake at least 1000mg per day
  • Fiber supplement if appropriate
  • Vitamin and mineral replacement based on abnormal laboratory testing

 


Screening/ Heath Promotion Activities (including vaccination recommendations)

  • Vaccination against Pneumococci, Haemophilus influenzae, meningococci

 


Anticipated Diet Education Needs

  • Maintain a strict gluten-free diet for life
  • Avoidance of lactose containing dairy products- lactose intolerance should resolve with recovery of intestinal villi
  • Avoidance of gluten-free oats
  • Referral to dietitian (who is knowledgeable about a gluten-free diet)
  • Encourage patient to join local celiac support group

 


Quick Text

Greater than 40 minutes of face-to-face time was spent with this patient today with over half this time involving: Gluten free diet education, rx medication management, counseling, and co-ordination of care. Many questions were answered  to pt satisfaction.
PLAN: Labs- including cbc, cmp, and vitamin/minerals. Comprehensive Gluten free diet discussed and handouts given.  Pt will initially avoid dairy in diet (for 2-3 months). Pt understands need for Gluten free diet is a life-long commitment to reduce risks of complications associated with malabsorption and  chronic inflammation-  including  Lymphoma. 100% Gluten free diet is recommended. Add super B complex (plus folic acid, vitamin d, and iron if indicated).