TABLE 1

Summary of Consensus Best Practices

Best PracticesInitial EvaluationFollow-up EvaluationGrade of EvidenceStrength of Statement
Bone
 1. Routine screening for bone health (biochemical studies and imaging)NoAt 1 y if previously abnormalaModerateWeak
 2. Measure 25-OH vitamin D levelYesOnly if previously abnormalLowWeak
 3. Measure bone density at 1 yNoOnly if previously abnormalModerateWeak
 4. Provide counseling on age-appropriate intake of calcium and vitamin D supplementation by a dietitianYesYesHighStrong
 5. Measure bone density in patients not adhering to GFD despite dietary counselingYesHighStrong
Hematology
 6. Routine screening for anemia (CBC, evaluation of mean cell volume, ferritin, iron, total iron-binding capacity)YesHighStrong
 7. Routinely obtain CBC at follow-up evaluationYesLowWeak
 8. Routine initial screening for folate deficiency (serum folate)NoVery lowWeak
Endocrine
 9. Routine screening for type 1 diabetesNoNoModerateStrong
 10. Routine counseling about signs and symptoms of diabetesYesLowWeak
 11. Routine screening for thyroid disease at time of diagnosis (thyrotropin)YesModerateStrong
 12. Routine screening for thyroid disease at follow-up (thyrotropin)YesModerateIntermediate
 13. Screening for thyroid disease using antithyroid antibodiesNoNoModerateStrong
Liver
 14. Routine screening for ALT and ASTYesOnly if previously abnormalHighModerate
 15. Screening for hepatitis B virus immunization statusYesOnly if previously abnormalModerateModerate
Nutrition
 16. Routine assessment of anthropometric measuresYesYesHighStrong
 17. Access to an experienced dietitianYesYesHighStrong
 18. Routine screening for Zn and other trace elements at time of diagnosisNoOnly if previously abnormalModerateWeak
 Exception: severe malabsorption, prolonged delay in diagnosis
 19. Routine vitamin supplementationYesModerateWeak
Testing
 20. Routine initial testing with quantitative IgA and IgA anti-tTG antibodyYesHighStrong
 21. Routine testing with IgA anti-tTG Ab at periodic intervals to help monitor compliance with GFDYesModerateStrong
 22. Use of IgA antiendomysial antibody limited to patients with comorbidities that increase the chance of false-positive tTG antibodiesYesYesModerateStrong
 23. Negative serologic evaluation cannot rule out CDYesHighStrong
 24. Consider use of HLA typing for children at risk for CD who have negative serologyYesModerateStrong
 25. Consider use of HLA typing for patients considered as diagnostic dilemmasYesModerateStrong
  • a Exception: severe malabsorption, prolonged delay in diagnosis, or bone disease symptoms at diagnosis.