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Expect Nonclassic Presentations
- Nonclassic celiac presentations are common and include constipation and obesity.
- Don't exclude celiac just because patients lack classic diarrhoea and weight loss.
Structured Post-Diagnosis Follow‑Up
- After diagnosis, refer to a knowledgeable dietitian, check bone density, and measure ferritin, vitamin D, B12 and liver tests.
- Recheck TTG at 4–6 months and 12 months, then annually; consider repeat biopsy at two years if indicated.
Confirm Equivocal Biopsies With HLA
- If biopsies show mild enteropathy with equivocal serology, check HLA DQ2/DQ8 to support or refute celiac disease.
- A negative HLA effectively excludes celiac and prevents unnecessary further testing.