Systematic review: The evidence base for long-term management of coeliac disease

Background While gluten‐free diet is an effective treatment for coeliac disease, the need for and goals of long‐term management of patients are poorly defined. Aim To review systematically the complications and associations of coeliac disease, to identify potential risk factors, to define ways of assessing risk factors and to provide a strategy for management. Methods Review of medical literature from 1975. Results There is an increasing list of potential complications and/or conditions associated with coeliac disease, in particular, autoimmune disease, malignancy and bone disease. Risk factors that may predict or influence long‐term outcomes include genetic susceptibility, environmental factors predominantly gluten ingestion, persistent small intestinal inflammation/injury and nutritional deficiencies. Genotyping of patients is yet to have an established clinical role in long‐term management. Assessment of adherence to the gluten‐free diet largely relies upon skilled dietary history, but the ultimate test is duodenal histopathology, which is the only currently established means of assessing healing. Symptoms, serology or other non‐invasive means are poor predictors of healing and the likelihood of complications. Conclusion Evidence (albeit limited) that adherence to a gluten‐free diet and mucosal healing prevent and/or ameliorate complications indicates that a planned long‐term strategy for follow‐up is essential.