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Nat Rev Gastroenterol Hepatol. 2015 Oct;12(10):580-91. doi: 10.1038/nrgastro.2015.156. Epub 2015 Sep 22.

Practical insights into gluten-free diets.

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Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
Department of Medicine, Building Finn-Medi 3, University of Tampere, Tampere, FI-33014, Finland.
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India.
Department of Gastroenterology, Central Clinical School, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia.
Division of Gastroenterology and Department of Immunology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.


Coeliac disease is a global disease, and the only currently available treatment is a gluten-free diet (GFD). Although conceptually simple, the diet changes are substantial and have a profound effect on a patient's life. Untreated coeliac disease is associated with complications, including excess mortality, most of which can be avoided with a strict GFD. However, there are many barriers, including availability, cost and safety of gluten-free foods, and gluten cross-contamination. The GFD can be restrictive in social situations, leading to poor quality of life and, ultimately, nonadherence. As the number of patients with coeliac disease increases worldwide, clinicians need to be aware of the challenges patients face. Heightened awareness by physicians, dietitians and other providers can help maximize successful treatment, improve outcomes, and reduce health-care costs and disease burden. Routine follow-up is necessary to reinforce the need for a GFD, provide social and emotional support, and achieve mucosal healing, leading to reduced risk of complications. Unfortunately, there is wide variation in follow-up practices. The objective of this Review is to increase awareness of the challenges, management and follow-up of patients with coeliac disease to help them achieve GFD adherence and prevent complications whilst preserving their quality of life.

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