Key priorities for implementation

The following recommendations have been identified as priorities for implementation. The full list of recommendations is in the recommendations section.

Recognition of coeliac disease

  • Offer serological testing for coeliac disease to:

    • people with any of the following:

      • persistent unexplained abdominal or gastrointestinal symptoms

      • faltering growth

      • prolonged fatigue

      • unexpected weight loss

      • severe or persistent mouth ulcers

      • unexplained iron, vitamin B12 or folate deficiency

      • type 1 diabetes, at diagnosis

      • autoimmune thyroid disease, at diagnosis

      • irritable bowel syndrome (in adults)

    • first‑degree relatives of people with coeliac disease.

  • For people undergoing investigations for coeliac disease:

    • explain that any test is accurate only if a gluten‑containing diet is eaten during the diagnostic process and

    • advise the person not to start a gluten‑free diet until diagnosis is confirmed by a specialist, even if the results of a serological test are positive.

Serological testing for coeliac disease

  • When healthcare professionals request serological tests to investigate suspected coeliac disease in young people and adults, laboratories should:

    • test for total immunoglobulin A (IgA) and IgA tissue transglutaminase (tTG) as the first choice

    • use IgA endomysial antibodies (EMA) if IgA tTG is weakly positive

    • consider using IgG EMA, IgG deamidated gliadin peptide (DGP) or IgG tTG if IgA is deficient[1].

  • When healthcare professionals request serological tests to investigate suspected coeliac disease in children, laboratories should:

    • test for total IgA and IgA tTG, as the first choice

    • consider using IgG EMA, IgG DGP or IgG tTG if IgA is deficient[1].

Monitoring in people with coeliac disease

  • Offer an annual review to people with coeliac disease. During the review:

    • measure weight and height

    • review symptoms

    • consider the need for assessment of diet and adherence to the gluten‑free diet

    • consider the need for specialist dietetic and nutritional advice.

Non‑responsive and refractory coeliac disease

  • Consider the following actions in people with coeliac disease who have persistent symptoms despite advice to exclude gluten from their diet:

    • review the certainty of the original diagnosis

    • refer the person to a specialist dietitian to investigate continued exposure to gluten

    • investigate potential complications or coexisting conditions that may be causing persistent symptoms, such as irritable bowel syndrome, lactose intolerance, bacterial overgrowth, microscopic colitis or inflammatory colitis.

Information and support

  • A healthcare professional with a specialist knowledge of coeliac disease should tell people with a confirmed diagnosis of coeliac disease (and their family members or carers, where appropriate) about the importance of a gluten‑free diet and give them information to help them follow it. This should include:

    • information on which types of food contain gluten and suitable alternatives, including gluten‑free substitutes

    • explanations of food labelling

    • information sources about gluten‑free diets, recipe ideas and cookbooks

    • how to manage social situations, eating out and travelling away from home, including travel abroad

    • avoiding cross‑contamination in the home and minimising the risk of accidental gluten intake when eating out

    • the role of national and local coeliac support groups.



[1] IgA deficiency is defined as total IgA less than 0.07 g per litre.

  • National Institute for Health and Care Excellence (NICE)