Symposium 1: Joint BAPEN and British Society of Gastroenterology Symposium on ‘Coeliac disease: basics and controversies’ Dietitians are better than clinicians in following up coeliac disease

Abstract

It seems obvious to healthcare professionals that patients with coeliac disease should receive regular follow-up. Surprisingly, there is little evidence that patients benefit in terms of reduced morbidity or mortality. However, several authoritative bodies have published guidelines on the management of coeliac disease that recommend regular follow-up. There is good evidence that compliance with a gluten-free diet reduces the risk of complications such as osteoporosis or small bowel lymphoma. Compliance is enhanced particularly by education about the disease and the gluten-free diet and by support from peers or professionals. Such input can be provided by regular follow-up, which thereby should improve compliance and hence long-term health. The consensus of the recommendations for follow-up suggests an annual review by a physician and dietitian. At annual follow-up the disease status can be checked and nutritional advice can be given, including checking the adequacy of, and the compliance with, the gluten-free diet. Complications and associated medical conditions can be sought, genetic risks explained and support and reassurance given. Specialist dietitians have particular expertise in relation to diet and nutritional management; specialist clinicians have a broader range of expertise in many aspects of management of the disease. A team approach for providing follow-up is the ideal, with a clinician and dietitian, both with expertise in coeliac disease, being involved. No one particular group of healthcare professionals is necessarily better than the other at providing follow-up.

Patient and Parent Satisfaction with a Dietitian-and Nurse-Led Celiac Disease Clinic for Children at the Stollery Children’S Hospital, Edmonton, Alberta

“…Lack of adherence to the GFD has shown that this treatment is clearly a challenge for sufferers and requires significant adjustment for them and their families. Studies have shown that consistent follow-up, support and encouragement from dietitians and doctors are necessary for the well-being of patients with CD (8,17). We believe that our clinic represents a novel and effective means to provide this support.…”

“…A GFD can be demanding and expensive; the dietitian can ensure that patients achieve their nutritional goals and give them the knowledge to add variety to their meals. Along with their knowledge of nutrition, dietitians are practiced in motivational interviewing, providing the encouragement needed for a patient to make a lifestyle change (17). The educational package given to the patients and families in our clinic includes a general guide to CD and nutritional handouts (18)(19)(20) regarding a GFD.…”

A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease

“…We concluded that in our local community either physicians, patients, or both do not always want a biopsy to confirm CD. These children do not receive appropriate diagnostic confirmation and are also missing out on the support and education our clinic provides [ 4 , 23 , 24 ]. Hence, we undertook to pilot a SD approach in our clinic.…”

Limited availability and higher cost of gluten‐free foods

“…, 2009; Roma et al. , 2010), which is particularly important because gluten re‐exposure results in villous damage and an increased risk of osteoporosis and malignancy (Stuckey et al. , 2009).…”