Diarrhea, weight loss, iron deficiency (no GI bleed), dermatitis herpetiformis
Most accurate: Anti-tTG IgA (+ total IgA) → duodenal biopsy (villous atrophy) while on gluten
Treat: Lifelong gluten-free diet
Order set
- Anti-tTG IgA + total IgA
- Duodenal biopsy (on gluten)
- FBC, iron, B12, folate, vit D
- DEXA
Criteria
AdmitSevere malabsorption / crisis
DischargeGluten-free diet + dietitian, deficiencies corrected
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Refractory disease
- Weight loss (exclude lymphoma)
Differentials
- IBS
- Lactose intolerance
- Tropical sprue
- SIBO
Common mistakes
- Testing off gluten
- Missing IgA deficiency
Disposition & follow-up
Lifelong gluten-free diet; dietitian; monitor healing.
Discharge package
MedicationsCorrect deficiencies
Follow-upDietitian; recheck serology/healing
VaccinationPneumococcal (hyposplenism risk)
LifestyleStrict lifelong gluten-free diet
Warning symptomsPersistent symptoms, weight loss
💊 Treatment detail — doses & preparation
Gluten-free dietdefinitive
DoseStrict lifelong GFD — dietitian review; oats only if certified GF
Preparation—
MonitortTG-IgA at 6–12 mo (falls with adherence)
Ferrous sulfateoral iron
Dose325 mg (65 mg elemental) OD or alternate days on empty stomach + vitamin C
Preparation325 mg tablets/elixir; alternate-day dosing absorbs better (hepcidin)
MonitorHb in 2–4 wk (reticulocytes by day 7); GI upset, black stools — counsel
Folic acidvitamin
Dose5 mg OD (deficiency/methotrexate cover — give on non-MTX days)
Preparation5 mg tablets
MonitorCorrect B12 deficiency FIRST if coexisting
Cholecalciferolvitamin D
DoseLoad 50,000 IU weekly ×6–8 wk (deficiency), then 800–1000 IU OD
PreparationCapsules/ampoules
MonitorCa²⁺, 25-OH-D after loading
Dapsone (dermatitis herpetiformis)skin
Dose50–150 mg OD until GFD controls rash
Preparation25/100 mg tablets
MonitorG6PD first; methaemoglobinaemia, haemolysis
📖 ACG / BSG CoeliacReviewed July 2026