Celiac Disease Follow-Up: Routine Tests You Should Keep Up With

Getting diagnosed with celiac disease can feel like a finish line — finally, an explanation. But clinically, it is more accurate to think of diagnosis as the starting point. The gluten-free diet is the cornerstone of treatment, yet follow-up is what helps confirm healing, reduce complications, and catch problems early.

The goal of routine monitoring is simple: make sure the gut is recovering, nutrition is stable, symptoms make sense, and hidden gluten exposure (or another condition) is not quietly undermining your health.

First: What “Routine Follow-Up” Usually Includes

Follow-up plans vary by country, clinician, age, pregnancy status, symptoms, and how severe malabsorption was at diagnosis. Still, most care pathways tend to revisit four pillars: symptoms, diet, celiac antibodies, and nutritional status.

1) Celiac Antibody Blood Tests

In many people, antibody levels decline after starting a strict gluten-free diet — often over months, not days. Clinicians commonly track:

• Tissue transglutaminase IgA (tTG-IgA) (most commonly used follow-up marker)
• Total IgA (to ensure IgA deficiency is not masking results)
• Deamidated gliadin peptide antibodies (DGP) (sometimes used, especially in certain contexts)

A persistent elevation can suggest ongoing gluten exposure, slow healing, or — less commonly — refractory disease. But antibody tests are not perfect: some people feel well before antibodies normalize, and others have symptoms despite reassuring bloodwork.

2) Nutrient and Anemia Screening

Because celiac disease can affect absorption, doctors often monitor nutrients that are commonly impacted — especially during the first year after diagnosis.

Common lab checks

• Complete blood count (CBC) (anemia screening)
• Iron studies (ferritin, transferrin saturation)
• Folate and Vitamin B12
• Vitamin D
• Calcium and sometimes parathyroid hormone (PTH)
• Zinc (sometimes, especially if symptoms persist)
• Magnesium (case-dependent)

The exact panel differs, but the underlying logic is consistent: verify that nutrition is re-stabilizing once gluten is removed.

3) Liver, Thyroid, and Other “Associated Condition” Checks

Celiac disease is associated with certain autoimmune conditions. That does not mean everyone will develop them — but screening is sometimes considered, particularly if symptoms suggest it.

• Thyroid tests (e.g., TSH, sometimes free T4) — due to autoimmune thyroid disease association
• Liver enzymes (ALT/AST) — mild elevation can occur in untreated celiac disease and may normalize
• Glucose or HbA1c — especially if there is family history or symptoms

4) Bone Health Monitoring

Untreated celiac disease can reduce bone mineral density due to inflammation and nutrient malabsorption (particularly calcium and vitamin D). Many clinicians consider bone assessment in adults at diagnosis or during follow-up depending on risk factors.

A bone density scan (DEXA) may be recommended in adults, especially if there was long-standing disease, low BMI, fractures, delayed diagnosis, or other osteoporosis risk factors.

5) Diet Review: The Most Underrated “Test”

Celiac disease monitoring is not only lab-based. A careful diet review is often the fastest way to identify hidden gluten sources — cross-contact, ingredient confusion, mislabeled foods, supplements, medications, or “gluten-free” products not safe enough for your sensitivity.

How Often Should You Do These Tests?

Many follow-up pathways include an early review within months after diagnosis, then repeat monitoring depending on progress. The exact schedule is personalized — and should be.

If you were severely symptomatic, had anemia or nutrient deficiencies, or struggle with accidental gluten exposure, your clinician may recommend tighter follow-up. If you are stable, symptom-free, and labs normalize, follow-up may be less frequent.

What Should Prompt an Earlier Check-In?

• Ongoing diarrhea, bloating, abdominal pain, or weight loss
• New fatigue, brain fog, or recurrent mouth ulcers
• Return of anemia or unexplained low iron
• Bone pain, fractures, or concerns about osteoporosis
• Pregnancy planning, pregnancy, or growth concerns in children