title: Long-term care for patients with coeliac disease in the UK: a review of the literature and future directions.
abstract: Coeliac disease is a common digestive disorder that affects 1% of adults. It is characterised by mucosal damage of the small intestine caused by dietary gluten. The main treatment for coeliac disease is a lifelong gluten-free diet, which can reduce morbidity and mortality and also improve quality of life. Despite the benefits, adhering to this diet is often challenging, with patients often struggling to sustain dietary restriction. Structured follow-up for coeliac disease is recommended in international guidelines for improving adherence and for detecting complications;however, uncertainty exists concerning exactly who should be administering this follow-up care. Here, we undertake a review of the current approaches described in the literature to follow-up patients with coeliac disease, and assess the efficacy of these differing models. We also explore future directions for the care of these patients in the context of the UK National Health Service (a publicly funded healthcare system). Although the focus of this review pertains to follow-up within the UK healthcare system, these problems are recognised to be international, and so the findings of our review are likely to be of interest to all healthcare professionals seeing and managing patients with coeliac disease.
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. matthew.kurien@sth.nhs.uk.|Academic Unit of Gastroenterology, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK. matthew.kurien@sth.nhs.uk.
authors.forename: M
authors.initials: M
authors.lastname: Kurien
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors.forename: N
authors.initials: N
authors.lastname: Trott
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.|Academic Unit of Gastroenterology, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK.
authors.forename: D S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D000359:Aftercare / Q000191:economics; D000375:Aging; D002446:Celiac Disease / Q000178:diet therapy* / Q000191:economics / Q000503:physiopathology / Q000628:therapy; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000191:economics; D017281:Cost of Illness; D055050:Diet, Gluten-Free / Q000009:adverse effects / Q000191:economics; D005762:Gastroenterology / Q000191:economics / Q000379:methods*; D017048:Health Care Costs; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D020380:Needs Assessment; D015596:Nutrition Assessment; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012720:Severity of Illness Index; D006113:United Kingdom
keywords: adherence; coeliac disease; efficacy; follow-up