Education, support and follow-up are key to successful management of coeliac disease
Poor quality of life can lead to nonadherence and poor control of coeliac disease
Resources for management of coeliac disease have improved in developed countries, but are lacking in developing countries
Strict adherence to a gluten-free diet is necessary for mucosal healing and prevention of complications
Ongoing gluten ingestion (primarily inadvertent) is the leading cause of nonresponsive coeliac disease
Certain subsets of patients might need more intense or individualized attention (management strategies)
Coeliac disease is a global disease, and the only currently available treatment is a gluten-free diet (GFD). Although conceptually simple, the diet changes are substantial and have a profound effect on a patient's life. Untreated coeliac disease is associated with complications, including excess mortality, most of which can be avoided with a strict GFD. However, there are many barriers, including availability, cost and safety of gluten-free foods, and gluten cross-contamination. The GFD can be restrictive in social situations, leading to poor quality of life and, ultimately, nonadherence. As the number of patients with coeliac disease increases worldwide, clinicians need to be aware of the challenges patients face. Heightened awareness by physicians, dietitians and other providers can help maximize successful treatment, improve outcomes, and reduce health-care costs and disease burden. Routine follow-up is necessary to reinforce the need for a GFD, provide social and emotional support, and achieve mucosal healing, leading to reduced risk of complications. Unfortunately, there is wide variation in follow-up practices. The objective of this Review is to increase awareness of the challenges, management and follow-up of patients with coeliac disease to help them achieve GFD adherence and prevent complications whilst preserving their quality of life.
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Fuchs, V. et al. Factors associated with long diagnostic delay in celiac disease. Scand. J. Gastroenterol. 49, 1304–1310 (2014).
Ukkola, A. et al. Patients' experiences and perceptions of living with coeliac disease—implications for optimizing care. J. Gastrointestin. Liver Dis. 21, 17–22 (2012).
Case, S. The gluten-free diet: how to provide effective education and resources. Gastroenterology 128, S128–S134 (2005).
Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H. & Murray, J. A. ACG clinical guidelines: diagnosis and management of celiac disease. Am. J. Gastroenterol. 108, 656–676 (2013).
Murray, J. A. (ed.) Mayo Clinic Going Gluten Free (Mayo Foundation for Medical Education and Research, 2014).
Ludvigsson, J. F. et al. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut 63, 1210–1228 (2014).
Husby, S. et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J. Pediatr. Gastroenterol. Nutr. 54, 136–160 (2012).
Hill, I. D. et al. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J. Pediatr. Gastroenterol. Nutr. 40, 1–19 (2005).
Ciacci, C., Iavarone, A., Siniscalchi, M., Romano, R. & De Rosa, A. Psychological dimensions of celiac disease: toward an integrated approach. Dig. Dis. Sci. 47, 2082–2087 (2002).
Hauser, W., Stallmach, A., Caspary, W. F. & Stein, J. Predictors of reduced health-related quality of life in adults with coeliac disease. Aliment. Pharmacol. Ther. 25, 569–578 (2007).
National Institutes of Health Consensus Development Conference Statement on Celiac Disease, June 28–30, 2004. Gastroenterology 128, S1–S9 (2005).
Gregory, S. Living with chronic illness in the family setting. Sociol. Health Illn. 27, 372–392 (2005).
Anson, O., Weizman, Z. & Zeevi, N. Celiac disease: parental knowledge and attitudes of dietary compliance. Pediatrics 85, 98–103 (1990).
Sverker, A., Ostlund, G., Hallert, C. & Hensing, G. Sharing life with a gluten-intolerant person—the perspective of close relatives. J. Hum. Nutr. Diet 20, 412–422 (2007).
Leffler, D. A. et al. Factors that influence adherence to a gluten-free diet in adults with celiac disease. Dig. Dis. Sci. 53, 1573–1581 (2008).
McNally, S. L. et al. Can. consumers trust web-based information about celiac disease? Accuracy, comprehensiveness, transparency, and readability of information on the internet. Interact. J. Med. Res. 1, e1 (2012).
Sainsbury, K., Mullan, B. & Sharpe, L. A randomized controlled trial of an online intervention to improve gluten-free diet adherence in celiac disease. Am. J. Gastroenterol. 108, 811–817 (2013).
United States Department of Agriculture. Grain: World markets and trade. USDA [online], (2015).
Chen, C. Y. et al. Avenanthramides and phenolic acids from oats are bioavailable and act synergistically with vitamin C to enhance hamster and human LDL resistance to oxidation. J. Nutr. 134, 1459–1466 (2004).
Storsrud, S., Hulthen, L. R. & Lenner, R. A. Beneficial effects of oats in the gluten-free diet of adults with special reference to nutrient status, symptoms and subjective experiences. Br. J. Nutr. 90, 101–107 (2003).
Peraaho, M. et al. Oats can diversify a gluten-free diet in celiac disease and dermatitis herpetiformis. J. Am. Diet Assoc. 104, 1148–1150 (2004).
Janatuinen, E. K. et al. No harm from five year ingestion of oats in coeliac disease. Gut 50, 332–335 (2002).
Kaukinen, K., Collin, P., Huhtala, H. & Maki, M. Long-term consumption of oats in adult celiac disease patients. Nutrients 5, 4380–4389 (2013).
Pulido, O. M. et al. Introduction of oats in the diet of individuals with celiac disease: a systematic review. Adv. Food Nutr. Res. 57, 235–285 (2009).
Ilus, T. et al. Persistent duodenal intraepithelial lymphocytosis despite a long-term strict gluten-free diet in celiac disease. Am. J. Gastroenterol. 107, 1563–1569 (2012).
Ilus, T., Kaukinen, K., Virta, L. J., Pukkala, E. & Collin, P. Incidence of malignancies in diagnosed celiac patients: a population-based estimate. Am. J. Gastroenterol. 109, 1471–1477 (2014).
Ilus, T. et al. Refractory coeliac disease in a country with a high prevalence of clinically-diagnosed coeliac disease. Aliment. Pharmacol. Ther. 39, 418–425 (2014).
Thompson, T., Lee, A. R. & Grace, T. Gluten contamination of grains, seeds, and flours in the United States: a pilot study. J. Am. Diet Assoc. 110, 937–940 (2010).
Arentz-Hansen, H. et al. The molecular basis for oat intolerance in patients with celiac disease. PLoS Med. 1, e1 (2004).
Peraaho, M. et al. Effect of an oats-containing gluten-free diet on symptoms and quality of life in coeliac disease. A randomized study. Scand. J. Gastroenterol. 39, 27–31 (2004).
Vader, L. W. et al. Characterization of cereal toxicity for celiac disease patients based on protein homology in grains. Gastroenterology 125, 1105–1113 (2003).
Comino, I. et al. Diversity in oat potential immunogenicity: basis for the selection of oat varieties with no toxicity in coeliac disease. Gut 60, 915–922 (2011).
Health Canada. Food and Nutrition: Gluten-free labelling claims for products containing specially produced “gluten-free oats”. Health Canada [online], (2015).
Pietzak, M. Gluten-free food labeling in the United States. J. Pediatr. Gastroenterol. Nutr. 41, 567–568 (2005).
Codex Alimentarius International Food Standards. Codex Standard for foods for special dietary use for persons intolerant to gluten. Codex Stan 118–1979. Codex Alimentarius [online], (2015).
Commission of the European Communities. Commission Regulation (EC) No 41/2009 of 20 January 2009 concerning the composition and labelling of foodstuffs suitable for people intolerant to gluten. Official Journal of the European Union [online], (2015).
US Department of Human and Health Services. Small entity compliance guide: gluten-free labeling of foods. FDA: US Food and Drug Administration [online], (2015).
Collin, P., Thorell, L., Kaukinen, K. & Maki, M. The safe threshold for gluten contamination in gluten-free products. Can. trace amounts be accepted in the treatment of coeliac disease? Aliment. Pharmacol. Ther. 19, 1277–1283 (2004).
Hischenhuber, C. et al. Review article: safe amounts of gluten for patients with wheat allergy or coeliac disease. Aliment. Pharmacol. Ther. 23, 559–575 (2006).
Catassi, C. et al. A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease. Am. J. Clin. Nutr. 85, 160–166 (2007).
US Department of Human and Health Services. Food Allergen Labeling and Consumer Protection Act of 2004 (Public Law 108–282, Title II). FDA: US Food and Drug Administration [online], (2015).
US Department of Human and Health Services. Gluten-free labeling of foods. DA: US Food and Drug Administration [online], (2015).
MacCulloch, K. & Rashid, M. Factors affecting adherence to a gluten-free diet in children with celiac disease. Paediatr. Child. Health 19, 305–309 (2014).
Errichiello, S. et al. Celiac disease: predictors of compliance with a gluten-free diet in adolescents and young adults. J. Pediatr. Gastroenterol. Nutr. 50, 54–60 (2010).
Lee, A. R., Ng, D. L., Diamond, B., Ciaccio, E. J. & Green, P. H. Living with coeliac disease: survey results from the USA. J. Hum. Nutr. Diet 25, 233–238 (2012).
Singh, J. & Whelan, K. Limited availability and higher cost of gluten-free foods. J. Hum. Nutr. Diet 24, 479–486 (2011).
Lee, A. R., Ng, D. L., Zivin, J. & Green, P. H. Economic burden of a gluten-free diet. J. Hum. Nutr. Diet 20, 423–430 (2007).
Stevens, L. & Rashid, M. Gluten-free and regular foods: a cost comparison. Can. J. Diet Pract Res. 69, 147–150 (2008).
West, J., Fleming, K. M., Tata, L. J., Card, T. R. & Crooks, C. J. Incidence and prevalence of celiac disease and dermatitis herpetiformis in the UK over two decades: population-based study. Am. J. Gastroenterol. 109, 757–768 (2014).
Kang, J. Y., Kang, A. H., Green, A., Gwee, K. A. & Ho, K. Y. Systematic review: worldwide variation in the frequency of coeliac disease and changes over time. Aliment. Pharmacol. Ther. 38, 226–245 (2013).
Rubio-Tapia, A., Ludvigsson, J. F., Brantner, T. L., Murray, J. A. & Everhart, J. E. The prevalence of celiac disease in the United States. Am. J. Gastroenterol. 107, 1538–1544; quiz 1537, 1545 (2012).
NPD Group. Gluten-free eating: behind the buzz. NPD Group [online], (2015).
Tavakkoli, A., Lewis, S. K., Tennyson, C. A., Lebwohl, B. & Green, P. H. Characteristics of patients who avoid wheat and/or gluten in the absence of celiac disease. Dig. Dis. Sci. 59, 1255–1261 (2014).
Topper, A. Non-celiacs drive gluten-free market growth. Mintel [online], (2014).
Rose, C. & Howard, R. Living with coeliac disease: a grounded theory study. J. Hum. Nutr. Diet 27, 30–40 (2014).
Zarkadas, M. et al. Living with coeliac disease and a gluten-free diet: a Canadian perspective. J. Hum. Nutr. Diet 26, 10–23 (2013).
Shah, S. et al. Patient perception of treatment burden is high in celiac disease compared with other common conditions. Am. J. Gastroenterol. 109, 1304–1311 (2014).
Karajeh, M. A., Hurlstone, D. P., Patel, T. M. & Sanders, D. S. Chefs' knowledge of coeliac disease (compared to the public): a questionnaire survey from the United Kingdom. Clin. Nutr. 24, 206–210 (2005).
Aziz, I. et al. Change in awareness of gluten-related disorders among chefs and the general public in the UK: a 10-year follow-up study. Eur. J. Gastroenterol. Hepatol 26, 1228–1233 (2014).
Cruz, J. E., Cocchio, C., Lai, P. T. & Hermes-DeSantis, E. Gluten content of medications. Am. J. Health Syst. Pharm. 72, 54–60 (2015).
Mangione, R. A., Patel, P. N., Shin, E. & Fiebert, J. Determining the gluten content of nonprescription drugs: information for patients with celiac disease. J. Am. Pharm. Assoc. 51, 734–737 (2011).
Sharrett, M. K. & Cureton, P. Kids and the gluten-free diet. Pract. Gastroenterol. 31, 49–65 (2007).
National Foundation for Celiac Awareness. Celiac Central. Free resources for gluten-free kids & parents. National Foundation for Celiac Awareness [online], (2015).
National Foundation for Celiac Awareness. Celiac Central. Going to college gluten-free. National Foundation for Celiac Awareness [online], (2015).
Dennis, M. & Leffler, D. A. (eds). in Real Life with Celiac Disease—Troubleshooting and Thriving Gluten Free 213–216 (AGA Press, 2010).
Choung, R. S. et al. Trends and racial/ethnic disparities in gluten-sensitive problems in the United States: findings from the national health and nutrition examination surveys from 1988 to 2012. Am. J. Gastroenterol. 110, 455–461 (2015).
Vilppula, A. et al. Increasing prevalence and high incidence of celiac disease in elderly people: a population-based study. BMC Gastroenterol. 9, 49 (2009).
Rashtak, S. & Murray, J. A. Celiac disease in the elderly. Gastroenterol. Clin. North Am. 38, 433–446 (2009).
Johnson, M. W., Ellis, H. J., Asante, M. A. & Ciclitira, P. J. Celiac disease in the elderly. Nat. Clin. Pract. Gastroenterol. Hepatol. 5, 697–706 (2008).
Casella, S. et al. Celiac disease in elderly adults: clinical, serological, and histological characteristics and the effect of a gluten-free diet. J. Am. Geriatr. Soc. 60, 1064–1069 (2012).
Godfrey, J. D. et al. Morbidity and mortality among older individuals with undiagnosed celiac disease. Gastroenterology 139, 763–769 (2010).
Lanzini, A. et al. Complete recovery of intestinal mucosa occurs very rarely in adult coeliac patients despite adherence to gluten-free diet. Aliment. Pharmacol. Ther. 29, 1299–1308 (2009).
Jafri, M. R. et al. Long-term fracture risk in patients with celiac disease: a population-based study in Olmsted County, Minnesota. Dig. Dis. Sci. 53, 964–971 (2008).
Ludvigsson, J. F., Michaelsson, K., Ekbom, A. & Montgomery, S. M. Coeliac disease and the risk of fractures—a general population-based cohort study. Aliment. Pharmacol. Ther. 25, 273–285 (2007).
Rubio-Tapia, A. et al. Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet. Am. J. Gastroenterol. 105, 1412–1420 (2010).
Lebwohl, B. et al. Mucosal healing and risk for lymphoproliferative malignancy in celiac disease: a population-based cohort study. Ann. Intern. Med. 159, 169–175 (2013).
Elfstrom, P., Sundstrom, J. & Ludvigsson, J. F. Systematic review with meta-analysis: associations between coeliac disease and type 1 diabetes. Aliment. Pharmacol. Ther. 40, 1123–1132 (2014).
Bybrant, M. C., Ortqvist, E., Lantz, S. & Grahnquist, L. High prevalence of celiac disease in Swedish children and adolescents with type 1 diabetes and the relation to the Swedish epidemic of celiac disease: a cohort study. Scand. J. Gastroenterol. 49, 52–58 (2014).
Mahmud, F. H. et al. Celiac disease in type 1 diabetes mellitus in a North American community: prevalence, serologic screening, and clinical features. Mayo Clin. Proc. 80, 1429–1434 (2005).
Abid, N., McGlone, O., Cardwell, C., McCallion, W. & Carson, D. Clinical and metabolic effects of gluten free diet in children with type 1 diabetes and coeliac disease. Pediatr. Diabetes 12, 322–325 (2011).
Sategna-Guidetti, C. et al. Celiac disease and insulin-dependent diabetes mellitus. Screening in an adult population. Dig. Dis. Sci. 39, 1633–1637 (1994).
Scaramuzza, A. E., Mantegazza, C., Bosetti, A. & Zuccotti, G. V. Type 1 diabetes and celiac disease: The effects of gluten free diet on metabolic control. World J. Diabetes 4, 130–134 (2013).
Kaukinen, K. et al. No effect of gluten-free diet on the metabolic control of type 1 diabetes in patients with diabetes and celiac disease. Retrospective and controlled prospective survey. Diabetes Care 22, 1747–1748 (1999).
Sanchez-Albisua, I. et al. Coeliac disease in children with Type 1 diabetes mellitus: the effect of the gluten-free diet. Diabet. Med. 22, 1079–1082 (2005).
Lohi, S. et al. Increasing prevalence of coeliac disease over time. Aliment. Pharmacol. Ther. 26, 1217–1225 (2007).
Sanders, D. S., Hopper, A. D., Leeds, J. S. & Hadjivassiliou, M. Screening for coeliac disease: But where does it take us? BMJ 336, 9 (2008).
Ukkola, A. et al. Diet improves perception of health and well-being in symptomatic, but not asymptomatic, patients with celiac disease. Clin. Gastroenterol. Hepatol. 9, 118–123 (2011).
Paavola, A. et al. Gastrointestinal symptoms and quality of life in screen-detected celiac disease. Dig. Liver Dis. 44, 814–818 (2012).
Fabiani, E. et al. Compliance with gluten-free diet in adolescents with screening-detected celiac disease: a 5-year follow-up study. J. Pediatr. 136, 841–843 (2000).
Hall, N. J., Rubin, G. & Charnock, A. Systematic review: adherence to a gluten-free diet in adult patients with coeliac disease. Aliment. Pharmacol. Ther. 30, 315–330 (2009).
World Gastroenterology Organisation: WGO Practice Guideline—Celiac Disease [online].
Cataldo, F. & Montalto, G. Celiac disease in the developing countries: a new and challenging public health problem. World J. Gastroenterol. 13, 2153–2159 (2007).
Sood, A., Midha, V., Sood, N., Avasthi, G. & Sehgal, A. Prevalence of celiac disease among school children in Punjab, North India. J. Gastroenterol. Hepatol. 21, 1622–1625 (2006).
Makharia, G. K. et al. Prevalence of celiac disease in the northern part of India: a community based study. J. Gastroenterol. Hepatol. 26, 894–900 (2011).
Wang, X. Q. et al. Celiac disease in children with diarrhea in 4 cities in China. J. Pediatr. Gastroenterol. Nutr. 53, 368–370 (2011).
Yuan, J. et al. The tip of the “celiac iceberg” in China: a systematic review and meta-analysis. PLoS ONE 8, e81151 (2013).
Makharia, G. K. et al. Issues associated with the emergence of coeliac disease in the Asia-Pacific region: a working party report of the World Gastroenterology Organization and the Asian Pacific Association of Gastroenterology. J. Gastroenterol. Hepatol. 29, 666–677 (2014).
Canadian Celiac Association. Enriching gluten-free foods in Canada [online].
Theethira, T. G., Dennis, M. & Leffler, D. A. Nutritional consequences of celiac disease and the gluten-free diet. Expert Rev. Gastroenterol. Hepatol. 8, 123–129 (2014).
Ohlund, K., Olsson, C., Hernell, O. & Ohlund, I. Dietary shortcomings in children on a gluten-free diet. J. Hum. Nutr. Diet 23, 294–300 (2010).
Wild, D., Robins, G. G., Burley, V. J. & Howdle, P. D. Evidence of high sugar intake, and low fibre and mineral intake, in the gluten-free diet. Aliment. Pharmacol. Ther. 32, 573–581 (2010).
Ferrara, P. et al. High fat consumption in children with celiac disease. Acta Gastroenterol. Belg. 72, 296–300 (2009).
Di Stefano, M., Mengoli, C., Bergonzi, M. & Corazza, G. R. Bone mass and mineral metabolism alterations in adult celiac disease: pathophysiology and clinical approach. Nutrients 5, 4786–4799 (2013).
National Osteoporosis Foundation. Physician's Guide to Prevention and Treatment of Osteoporosis (National Osteoporosis Foundation, 2005).
Franco, C. B. Osteoporosis in gastrointestinal diseases. Translat. Gastrointest. Cancer 4, 1–22 (2015).
Lebwohl, B., Murray, J. A., Rubio-Tapia, A., Green, P. H. & Ludvigsson, J. F. Predictors of persistent villous atrophy in coeliac disease: a population-based study. Aliment. Pharmacol. Ther. 39, 488–495 (2014).
Krupa-Kozak, U. Pathologic bone alterations in celiac disease: etiology, epidemiology, and treatment. Nutrition 30, 16–24 (2014).
Fouda, M. A. et al. Evaluation and management of skeletal health in celiac disease: position statement. Can. J. Gastroenterol. 26, 819–829 (2012).
Basso, M. S. et al. Association between celiac disease and primary lactase deficiency. Eur. J. Clin. Nutr. 66, 1364–1365 (2012).
Tucker, E., Rostami, K., Prabhakaran, S. & Al Dulaimi, D. Patients with coeliac disease are increasingly overweight or obese on presentation. J. Gastrointestin Liver Dis. 21, 11–15 (2012).
Reilly, N. R. et al. Celiac disease in normal-weight and overweight children: clinical features and growth outcomes following a gluten-free diet. J. Pediatr. Gastroenterol. Nutr. 53, 528–531 (2011).
Kabbani, T. A. et al. Body mass index and the risk of obesity in coeliac disease treated with the gluten-free diet. Aliment. Pharmacol. Ther. 35, 723–729 (2012).
Satherley, R., Howard, R. & Higgs, S. Disordered eating practices in gastrointestinal disorders. Appetite 84, 240–250 (2015).
Arigo, D., Anskis, A. M. & Smyth, J. M. Psychiatric comorbidities in women with celiac disease. Chronic Illn. 8, 45–55 (2012).
Karwautz, A. et al. Eating pathology in adolescents with celiac disease. Psychosomatics 49, 399–406 (2008).
Tortora, R. et al. Metabolic syndrome in patients with coeliac disease on a gluten-free diet. Aliment. Pharmacol. Ther. 41, 352–359 (2015).
Holmes, G. K., Prior, P., Lane, M. R., Pope, D. & Allan, R. N. Malignancy in coeliac disease—effect of a gluten free diet. Gut 30, 333–338 (1989).
Bardella, M. T. et al. Need for follow up in coeliac disease. Arch. Dis. Child. 70, 211–213 (1994).
Herman, M. L. et al. Patients with celiac disease are not followed up adequately. Clin. Gastroenterol. Hepatol. 10, 893–899.e891 (2012).
Jackson, P. T., Glasgow, J. F. & Thom, R. Parents' understanding of coeliac disease and diet. Arch. Dis. Child. 60, 672–674 (1985).
Kurppa, K. et al. Factors associated with dietary adherence in celiac disease: a nationwide study. Digestion 86, 309–314 (2012).
Kaukinen, K. et al. Persistent small bowel mucosal villous atrophy without symptoms in coeliac disease. Aliment. Pharmacol. Ther. 25, 1237–1245 (2007).
van Overbeek, F. M. et al. The daily gluten intake in relatives of patients with coeliac disease compared with that of the general Dutch population. Eur. J. Gastroenterol. Hepatol. 9, 1097–1099 (1997).
Paarlahti, P. et al. Predictors of persistent symptoms and reduced quality of life in treated coeliac disease patients: a large cross-sectional study. BMC Gastroenterol. 13, 75 (2013).
Leffler, D. A. et al. A simple validated gluten-free diet adherence survey for adults with celiac disease. Clin. Gastroenterol. Hepatol. 7, 530–536. e1–e2 (2009).
Biagi, F. et al. A gluten-free diet score to evaluate dietary compliance in patients with coeliac disease. Br. J. Nutr. 102, 882–887 (2009).
Sainsbury, K., Mullan, B. & Sharpe, L. Reduced quality of life in coeliac disease is more strongly associated with depression than gastrointestinal symptoms. J. Psychosom. Res. 75, 135–141 (2013).
Dorn, S. D. et al. Psychosocial factors are more important than disease activity in determining gastrointestinal symptoms and health status in adults at a celiac disease referral center. Dig. Dis. Sci. 55, 3154–3163 (2010).
Aziz, I. & Sanders, D. S. The irritable bowel syndrome-celiac disease connection. Gastrointest. Endosc. Clin. N. Am. 22, 623–637 (2012).
Kurien, M., Barratt, S. M. & Sanders, D. S. Functional gastrointestinal disorders and coeliac disease in adults—negative impact on quality of life. Aliment. Pharmacol. Ther. 34, 1044–1045; author reply 1045–1046 (2011).
Usai, P., Manca, R., Cuomo, R., Lai, M. A. & Boi, M. F. Effect of gluten-free diet and co-morbidity of irritable bowel syndrome-type symptoms on health-related quality of life in adult coeliac patients. Dig. Liver Dis. 39, 824–828 (2007).
Ford, A. C. et al. Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis. Arch. Intern. Med. 169, 651–658 (2009).
Zingone, F. et al. Psychological morbidity of celiac disease: a review of the literature. United European Gastroenterol. J. 3, 136–145 (2015).
van Hees, N. J., Van der Does, W. & Giltay, E. J. Coeliac disease, diet adherence and depressive symptoms. J. Psychosom Res. 74, 155–160 (2013).
Smith, D. F. & Gerdes, L. U. Meta-analysis on anxiety and depression in adult celiac disease. Acta Psychiatr. Scand. 125, 189–193 (2012).
Hauser, W., Musial, F., Caspary, W. F., Stein, J. & Stallmach, A. Predictors of irritable bowel-type symptoms and healthcare-seeking behavior among adults with celiac disease. Psychosom. Med. 69, 370–376 (2007).
Long, K. H. et al. The economics of coeliac disease: a population-based study. Aliment. Pharmacol. Ther. 32, 261–269 (2010).
Gray, A. M. & Papanicolas, I. N. Impact of symptoms on quality of life before and after diagnosis of coeliac disease: results from a UK population survey. BMC Health Serv. Res. 10, 105 (2010).
Lauriere, M. et al. Hydrolysed wheat proteins present in cosmetics can induce immediate hypersensitivities. Contact Dermatitis 54, 283–289 (2006).
Tammaro, A., Narcisi, A., De Marco, G. & Persechino, S. Cutaneous hypersensitivity to gluten. Dermatitis 23, 220–221 (2012).
Chiu, J. G., Shin, Y., Patel, P. N. & Mangione, R. A. Gluten content of barium sulfate suspensions used for barium swallows in patients with celiac disease. Radiol. Technol. 86, 11–16 (2014).
Rashid, M. et al. Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children. Pediatrics 116, e754–e759 (2005).
Monzani, A. et al. Use of deamidated gliadin peptide antibodies to monitor diet compliance in childhood celiac disease. J. Pediatr. Gastroenterol. Nutr. 53, 55–60 (2011).
Hopman, E. G., le Cessie, S., von Blomberg, B. M. & Mearin, M. L. Nutritional management of the gluten-free diet in young people with celiac disease in The Netherlands. J. Pediatr. Gastroenterol. Nutr. 43, 102–108 (2006).
Tapsas, D., Falth-Magnusson, K., Hogberg, L., Hammersjo, J. A. & Hollen, E. Swedish children with celiac disease comply well with a gluten-free diet, and most include oats without reporting any adverse effects: a long-term follow-up study. Nutr. Res. 34, 436–441 (2014).
Kurppa, K. et al. Benefits of a gluten-free diet for asymptomatic patients with serologic markers of celiac disease. Gastroenterology 147, 610–617.e611 (2014).
Wagner, G. et al. Quality of life in adolescents with treated coeliac disease: influence of compliance and age at diagnosis. J. Pediatr. Gastroenterol. Nutr. 47, 555–561 (2008).
Hartman, C. et al. Bone quantitative ultrasound and bone mineral density in children with celiac disease. J. Pediatr. Gastroenterol. Nutr. 39, 504–510 (2004).
Esenyel, S., Unal, F. & Vural, P. Depression and anxiety in child and adolescents with follow-up celiac disease and in their families. Turk. J. Gastroenterol. 25, 381–385 (2014).
Chauhan, J. C., Kumar, P., Dutta, A. K., Basu, S. & Kumar, A. Assessment of dietary compliance to gluten free diet and psychosocial problems in Indian children with celiac disease. Indian J. Pediatr. 77, 649–654 (2010).
Dorn, S. D. et al. The development and validation of a new coeliac disease quality of life survey (CD-QOL). Aliment. Pharmacol. Ther. 31, 666–675 (2010).
Sanchez, M. I. et al. Risk of fracture in celiac disease: gender, dietary compliance, or both? World J. Gastroenterol. 17, 3035–3042 (2011).
Barratt, S. M. et al. Reflux and irritable bowel syndrome are negative predictors of quality of life in coeliac disease and inflammatory bowel disease. Eur. J. Gastroenterol. Hepatol. 23, 159–165 (2011).
Whitaker, J. K., West, J., Holmes, G. K. & Logan, R. F. Patient perceptions of the burden of coeliac disease and its treatment in the UK. Aliment. Pharmacol. Ther. 29, 1131–1136 (2009).
Hutchinson, J. M., West, N. P., Robins, G. G. & Howdle, P. D. Long-term histological follow-up of people with coeliac disease in a UK teaching hospital. QJM 103, 511–517 (2010).
O'Leary, C. et al. Celiac disease and the transition from childhood to adulthood: a 28-year follow-up. Am. J. Gastroenterol. 99, 2437–2441 (2004).
Vahedi, K. et al. Reliability of antitransglutaminase antibodies as predictors of gluten-free diet compliance in adult celiac disease. Am. J. Gastroenterol. 98, 1079–1087 (2003)
Norstrom, F., Sandstrom, O., Lindholm, L. & Ivarsson, A. A gluten-free diet effectively reduces symptoms and health care consumption in a Swedish celiac disease population. BMC Gastroenterol. 12, 125 (2012).
Purnak, T. et al. Mean platelet volume could be a promising biomarker to monitor dietary compliance in celiac disease. Ups. J. Med. Sci. 116, 208–211 (2011).
The authors wish to thank D. I. Frank for her expert assistance in the preparation of this manuscript.
The authors declare no competing financial interests.
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See, J., Kaukinen, K., Makharia, G. et al. Practical insights into gluten-free diets. Nat Rev Gastroenterol Hepatol 12, 580–591 (2015). https://doi.org/10.1038/nrgastro.2015.156
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