General management of coeliac disease
Undiagnosed coeliac disease is associated with an increase in mortalityLebwohl, 2020, and a slight increase in gastrointestinal malignancy and lymphomaHan, 2015. Untreated coeliac disease, even in patients with few symptoms, increases the risk of osteoporosisZanchetta, 2016, iron-deficiency anaemia and miscarriageButler, 2011.
Investigate newly diagnosed patients for micronutrient deficiencies (including iron, vitamin B12, folate, and vitamin D) and screen adults for osteopenia by measuring bone density (see Assessing and interpreting bone status). Treat any deficiencies (see Fat-soluble vitamin deficiencies, Water-soluble vitamin deficiencies and Overview of iron deficiency) or bone disorders (see Osteoporosis)McGrogan, 2021.
At the time of diagnosis, test thyroid function as coeliac disease is associated with autoimmune thyroid diseases. Liver biochemistry should also be performed at the time of diagnosis—in rare cases coeliac disease is associated with abnormal liver function.