It seems obvious to healthcare professionals that patients with coeliac disease should receive regular follow-up. Surprisingly, there is little evidence that patients benefit in terms of reduced morbidity or mortality. However, several authoritative bodies have published guidelines on the management of coeliac disease that recommend regular follow-up. There is good evidence that compliance with a gluten-free diet reduces the risk of complications such as osteoporosis or small bowel lymphoma. Compliance is enhanced particularly by education about the disease and the gluten-free diet and by support from peers or professionals. Such input can be provided by regular follow-up, which thereby should improve compliance and hence long-term health. The consensus of the recommendations for follow-up suggests an annual review by a physician and dietitian. At annual follow-up the disease status can be checked and nutritional advice can be given, including checking the adequacy of, and the compliance with, the gluten-free diet. Complications and associated medical conditions can be sought, genetic risks explained and support and reassurance given. Specialist dietitians have particular expertise in relation to diet and nutritional management; specialist clinicians have a broader range of expertise in many aspects of management of the disease. A team approach for providing follow-up is the ideal, with a clinician and dietitian, both with expertise in coeliac disease, being involved. No one particular group of healthcare professionals is necessarily better than the other at providing follow-up.

Review of adults with coeliac disease is variable throughout the UK in terms of frequency, expertise, and the specialty of the health professionals undertaking the review. In this article, the author describes a dietitian-led virtual review clinic as a method for monitoring adults with established coeliac disease. Clinical audit of the first 24 months of running this service has shown that 91.7% of invited patients attended blood monitoring and returned a completed questionnaire for dietitian review. Moreover, 80% of patients reported that they prefer to alternate virtual review with face-to-face review annually rather than always attend an annual appointment. A virtual (telephone and postal) review clinic has been shown to be an effective method of reviewing adults with coeliac disease.

Malnutrition is both a cause and consequence of disease effecting up to 30% of patients admitted to hospital (1) and the public cost has been estimated at £13 billion a year (2) . The protected mealtime initiative (PMI), currently under the care of the national patient safety agency, aims to allow patients to eat their meals without unnecessary interruption and enable staff to assist those who are unable to eat independently (3) . Two years ago the PMI was introduced onto one ward at the Royal Bournemouth Hospital. Results of an audit showed a positive impact on the number of interruptions during the mealtime and the energy intake of patients (4) . Following this, protected mealtimes were introduced across the whole hospital. This audit, 6 months later, shows the effect on patients' mealtime experience and their energy intake.Over a 2 week period all patients in one 6-bedded bay in each ward were observed at a lunchtime by a dietitian. The number and reason for all non-urgent interruptions was recorded. The menu choices of each patient and amount consumed was recorded and the energy content of the meal estimated using a standardised tool. Patients nil-by-mouth or on clear fluids only were excluded. The data were compared with data collected in the previous year before protected mealtimes was introduced.Ninety seven patients were included in the baseline audit and 102 patients were included following the introduction of the PMI. At baseline, 45 % of patients experienced one or more non-urgent interruptions during the mealtime. This decreased to 29 % of patients after the PMI. The reason for interruptions can be seen below and a similar pattern was seen at baseline. The mean energy intake was 1907.904 kJ v. 2125.472 kJ (456 kcal v. 508 kcal) before and after PMI respectively. There was no difference in the intake of patients who were interrupted compared to those that were not.

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