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)

Medication Management (including vitamins & minerals)

  • Vitamin B complex if appropriate
  • Supplemental vitamin D based on vitamin D level
  • Calcium intake at least 1000mg per day
  • Fiber supplement if appropriate

Screening/ Heath Promotion Activities (including vaccination recommendations)

  • Bone density scan- to provide a baseline measure of bone mass
  • Influenza vaccination one dose annually
  • Consider repeat endoscopy with biopsy if antibodies remain elevated or become positive after 12 months of treatment

Anticipated Diet Education Needs

  • Evaluate dietary compliance and reinforce strict adherence
  • Encourage high-iron and high-folate foods
  • Recommend nutritionist (dietitian) consultation
  • Possible failure to respond to gluten-free diet
    • Consider unintentional or intentional gluten exposure
    • Evaluate for coexisting conditions (microscopic colitis, pancreatic insufficiency, small intestinal bacterial overgrowth, IBS, and food intolerances)

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, celiac serology, and vitamin/minerals. Comprehensive Gluten free diet discussed and handouts given.   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. Continue super B complex (plus folic acid, vitamin d, and iron if indicated). Yearly influenza vaccination recommended.