The gluten-free diet (GFD) remains a complex paradigm in managing celiac disease (CeD) in children and adults, and there are many reasons why GFD adherence should be strict to improve outcomes. However, this is a challenging task for patients, since they need to have access to quality healthcare resources that facilitate optimal GFD adherence. Understanding the strengths and weaknesses of the GFD, tackling coexisting nutritional deficiencies, and dealing with complex situations, such as seronegative CeD or non-responsive CeD, all require the involvement of a multidisciplinary team. The short- and long-term follow-up of CeD patients should preferably be performed by a combined Gastroenterology and Nutrition service with well-defined quality standards and the multidisciplinary involvement of physicians, nurses, dietitians, and psychologists. Nutritional advice and counseling by an experienced dietitian can reduce the costs associated with long-term follow-up of CeD patients. Likewise, psychological interventions may be essential in specific scenarios where implementing and sustaining a lifelong GFD can cause a significant psychological burden for patients. This manuscript aims to provide guidelines to improve clinical practice in the follow-up and monitoring of CeD patients and provide information on the nutritional risks of an ill-advised GFD. Clinicians, biochemists, food technologists, dietitians, and psychologists with a global view of the disease have been involved in its writing.

To explore patients' follow-up preferences. Optimal follow-up strategies for patients with coeliac disease remain a subject of debate. Research suggests patients' prefer review by dietitians with a doctor available as required. Patients with coeliac disease under review at our centre, completed a questionnaire assessing their views on what makes follow-up useful based on specific criteria. Bloods tests, symptoms review, dietary assessment, opportunity to ask questions and reassurance. Patients' preferences between follow-up with a hospital doctor, a hospital dietitian, a hospital dietitian with a doctor available, a general practitioner, no follow-up or access when needed were also evaluated. 138 adult patients completed the questionnaire, 80% of patients reported following a strict gluten free diet (mean diagnosis was 7.2 years). Overall, 60% found their follow-up to be 'very useful' valuing their review of blood tests and symptoms (71%) reassurance (60%) and opportunity to ask questions (58%). Follow-up by a dietitian with a doctor available was the most preferred option of review (p<0.001) except when compared to hospital doctor (p=0.75). Novel modalities of follow-up such as telephone and video reviews were regarded as of equal value to face-to-face appointments (65% and 62% respectively). Digital applications were significantly less preferable (38%, p<0.001). Follow-up by a dietitian with a doctor available as needed was the most preferred follow-up method. However, in this study follow-up by a dietitian with doctor available and hospital doctor alone was statistically equivalent. Many patients consider telephone and video follow-up of equal value to face-to-face reviews.

Introduction: UK guidance recommends adults living with coeliac disease (CD) receive annual care from a dietitian. However, many CD provisions have difficulties meeting these demands. The study aimed to evaluate a digital virtual annual review (VAR) tool as an alternative method of reviewing clinically stable adults with CD annually. Methods: This single‐centre retrospective study analysed data between September 2022 and March 2024. Adults living with CD, diagnosed for > 3 years and deemed clinically stable by a specialist CD dietitian, received a link to complete the digital VAR tool. Chi‐squared analysis assessed the relationship between demographics and engagement with the tool. Median value indicated clinician triage time. Outcomes of the triage process were presented as frequency and percentages. Ethical approval was obtained from local higher education institute, and information governance approval was received through local processes. Results: The majority (81.7%, n = 165) of service users engaged with the digital VAR tool. The demographics did not influence engagement. The specialist CD dietitian required 14 min on average to triage a singular digital VAR tool. Following triage, 72.4% ( n = 102) did not require interim input prior to their routine annual review. Only 22% ( n = 31) were deemed to require a follow‐up clinic appointment with the specialist CD dietitian to discuss symptoms or GF dietary adherence. Service users mainly preferred the digital VAR tool for future reviews (55%, n = 78). Conclusions: Our study provides supportive evidence for the effectiveness of a digital annual review tool to improve the efficiency of dietetic service provision for stable adults living with CD.