Guidance
Key priorities for implementation
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
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Offer serological testing for coeliac disease to:
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people with any of the following:
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persistent unexplained abdominal or gastrointestinal symptoms
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faltering growth
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prolonged fatigue
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unexpected weight loss
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severe or persistent mouth ulcers
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unexplained iron, vitamin B12 or folate deficiency
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type 1 diabetes, at diagnosis
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autoimmune thyroid disease, at diagnosis
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irritable bowel syndrome (in adults)
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first‑degree relatives of people with coeliac disease.
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For people undergoing investigations for coeliac disease:
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explain that any test is accurate only if a gluten‑containing diet is eaten during the diagnostic process and
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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.
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Serological testing for coeliac disease
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When healthcare professionals request serological tests to investigate suspected coeliac disease in young people and adults, laboratories should:
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test for total immunoglobulin A (IgA) and IgA tissue transglutaminase (tTG) as the first choice
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use IgA endomysial antibodies (EMA) if IgA tTG is weakly positive
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consider using IgG EMA, IgG deamidated gliadin peptide (DGP) or IgG tTG if IgA is deficient.
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When healthcare professionals request serological tests to investigate suspected coeliac disease in children, laboratories should:
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test for total IgA and IgA tTG, as the first choice
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consider using IgG EMA, IgG DGP or IgG tTG if IgA is deficient.
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Monitoring in people with coeliac disease
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Offer an annual review to people with coeliac disease. During the review:
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measure weight and height
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review symptoms
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consider the need for assessment of diet and adherence to the gluten‑free diet
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consider the need for specialist dietetic and nutritional advice.
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Non‑responsive and refractory coeliac disease
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Consider the following actions in people with coeliac disease who have persistent symptoms despite advice to exclude gluten from their diet:
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review the certainty of the original diagnosis
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refer the person to a specialist dietitian to investigate continued exposure to gluten
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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.
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Information and support
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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:
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information on which types of food contain gluten and suitable alternatives, including gluten‑free substitutes
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explanations of food labelling
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information sources about gluten‑free diets, recipe ideas and cookbooks
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how to manage social situations, eating out and travelling away from home, including travel abroad
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avoiding cross‑contamination in the home and minimising the risk of accidental gluten intake when eating out
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the role of national and local coeliac support groups.
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