More than 45% of CD patients still show intestinal damage even after following a GFD for a year9,10. Therefore, strict adherence to a GFD is essential to ensure that full recovery of the intestinal mucosa is achieved. A lack of mucosal recovery is likely to be associated with failing to adhere to the GFD, which can reach up to 54% in adult patients according to dietary questionnaires6.
A strict GFD reduces long-term complications, such as nutritional deficiencies, low bone mineral density and other health problems such as repeated abortions. In this sense, CD patients with a damaged intestinal mucosa are 4.3 times more at risk of developing non-Hodgkin lymphoma11.
Monitoring GFD during CD diagnosis is of great importance since it prevents false-negative serological markers in the diagnosis (e.g. type 2 anti-tissue transglutaminase antibodies) due to self-prescribed GFD before diagnosis, which reduces the levels of these markers. As a consequence, this considerably delays CD diagnosis and would therefore affect the quality of life of the patient.
Celiac patients or relatives (i.e. parents) must ensure that gluten-free products or meals eaten outside the home are of high quality and without gluten to avoid complications and CD-related symptoms12. Furthermore, the physician should know if the patient is adhering to a GFD, and if not, be able to identify the cause so as to advise the patient how to avoid exposure to gluten, or encourage him/her to be more consistent with their GFD.