Coeliac diseaseRefer

• Iron (elemental, if deficient), Calcium + Vitamin D3 (bone health)

• Test while still eating gluten: tTG-IgA + total IgA; if positive → duodenal biopsies (≥ 4 from D2 + 1–2 from the bulb) (ACG 2023)
• Gluten-free diet: No wheat (atta, maida, suji, dalia), barley or rye; oats only if uncontaminated; dietitian referral (ACG 2023)
• Follow-up: tTG at 6 and 12 months, then yearly; bone density in adults; pneumococcal vaccine (ACG 2023)

First visit

• Tissue transglutaminase IgA with total IgA — Test while still eating gluten.
• CBC, ferritin, folate, B12 — Deficiencies at diagnosis.

Only if indicated

• Upper GI endoscopy with duodenal biopsy — Confirms the diagnosis in adults.
• Bone density (DEXA) — Adults at diagnosis, especially postmenopausal women.
• TSH, blood glucose — Associated autoimmune disease.

Follow-up and monitoring

• tTG IgA at 6 and 12 months, then yearly — Should fall on a strict gluten-free diet.