At present, the primary treatment for coeliac disease is the removal of gluten from the diet. Strict life-long adherence to a gluten-free diet is essential as ingestion of even small quantities of gluten can be harmful. The gluten-free diet is a major undertaking and newly diagnosed coeliacs will require intensive education. The dietitian is the most qualified healthcare professional to provide this education.

It is essential that a gluten-free diet is commenced only after a definitive diagnosis of coeliac disease is made, i.e. after a positive serology result and endoscopy with a biopsy. Following a gluten-free diet during the diagnostic process may produce a false-negative result.

A number of guidelines on the diagnosis and management of coeliac disease exist, however, there are currently no standards designed in the Republic of Ireland. The Clinical Resource Efficiency Support Team or CREST (2006) guidelines, developed in Northern Ireland, may be of most relevance to us at present. The CREST guidelines recommend that a referral letter be sent to a dietitian upon the client’s diagnosis of coeliac disease and that, ideally, the dietitian should see the client within 1-2 weeks of diagnosis. The initial review dietetic appointment should take place 6-12 weeks following the initial consultation and be followed by a second review at 3-6 months depending on how the client is adapting to the new gluten-free diet and whether they have any nutritional issues, such as anaemia, osteoporosis, lactose intolerance, etc.. A client with a well controlled diet is then seen on a bi-annual or annual basis, unless there is clinical indication for an earlier review.

The Importance of the Gluten-Free Diet

A gluten-free diet is one that excludes wheat, rye and barley. The "Gluten-Free Living" section of this website provides useful information on foods and ingredients which are naturally gluten-free and the Food List provides information on manufactured foods which are gluten-free.

Strict, life-long adherence to the gluten-free diet is essential, to:

• Improve symptoms and well-being of the client
• Achieve a nutritionally balanced diet
• Promote growth and development in children
• Normalise gut mucosa
• Reduce risk of long-term complications

(CREST, 2006)