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
- Pneumococcal vaccine is advised
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.