Coeliac Disease

Recognition and assessment of coeliac disease in children and adults: summary of NICE guidance

Who should be offered serological testing for coeliac disease?

Offer testing to children and adults with any of the following signs and symptoms:

-Chronic or intermittent diarrhoea

-Failure to thrive or faltering growth (in children)

-Persistent and unexplained gastrointestinal symptoms including nausea or vomiting

-Prolonged fatigue

-Recurrent abdominal pain, cramping, or distension

-Sudden or unexpected weight loss

-Unexplained iron deficiency anaemia or other unspecified anaemia.

Advice to patients

• Inform people that testing for coeliac disease is accurate only if the person is eating a diet that contains gluten at the time of testing.
  
• Inform people that when following a normal gluten containing diet they should eat some gluten (for example, bread, chapattis, pasta, biscuits, or cakes) in more than one meal every day for a minimum of six weeks before testing.
  
• If a person is reluctant or unable to reintroduce gluten into their diet before testing refer them to a gastrointestinal specialist and inform them that it may be difficult to confirm a diagnosis of coeliac disease on intestinal biopsy.
  
• Inform people and their parents or carers that a delayed diagnosis of coeliac disease, or undiagnosed coeliac disease, can result in:
  

  -Continuing ill health
  

  -Long term complications, including osteoporosis and increased risk of fracture, unfavourable pregnancy outcomes, and a modest increased risk of intestinal malignancy
  

  -In children, growth failure, delayed puberty, and dental problems

  Serological tests
  

• All tests should be undertaken in laboratories with clinical pathology accreditation.
  
• Do not use IgG or IgA antigliadin antibody (AGA) tests in the diagnosis of coeliac disease.
  
• When clinicians request serology, laboratories should:
  

  -Use IgA tissue transglutaminase antibody (tTGA) testing as the first choice of test
  

  -Use IgA endomysial antibody (EMA) testing if the result of the IgA tissue transglutaminase antibody test is equivocal
  

  -Check for IgA deficiency if serology is negative (if the laboratory detects a low optical density on the IgA tTGA test, very low IgA tTGA results, or low background on the IgA EMA test)
  

  -Use IgG tissue transglutaminase antibody or IgG endomysial antibody tests (or both) for people with confirmed IgA deficiency
  

  Communicate clearly the results in terms of values, interpretation, and recommended action.