Coeliac Disease:
Overview, Diagnosis, and Treatment

About Coeliac Disease

Coeliac disease is an under-diagnosed, under- managed condition. Coeliac disease is no longer thought of as a classical presentation of malnutrition at childhood. It can present as one of several vague symptoms or disease comorbidities at any age.¹

More than 70%

More than 70% of patients with coeliac disease have yet to be diagnosed.¹⁰

The presence of coeliac disease in these patients is often 'hidden' so it is important to look for the truth by case-finding with the aid of coeliac serology.^11-21

Case-finding for coeliac disease in these high-risk populations is recommended.^11-21

Think Coeliac

Why should you case-find for coeliac disease in high-risk populations?

Test Coeliac

Which coeliac serology should you request to aid your differential diagnosis?

Treat Coeliac

What are the benefits of early diagnosis and management in coeliac disease?

Learn more about testing

The initial step toward a coeliac disease diagnosis is to test for coeliac-related antibodies.

Think Coeliac: Why case-find?

It is recommended that you consider serological testing for celiac disease in people with:^11-21

First or second-degree relatives who have coeliac disease
IBS
Type 1 diabetes
Sub-fertility and poor pregnancy outcomes
Persistent unexplained abdominal or gastrointestinal symptoms
Faltering growth
Prolonged fatigue
Unexpected weight loss
Unexplained iron, vitamin B12 or folate deficiency
Autoimmune thyroid disease, at diagnosis

Metabolic bone disorder (reduced bone mineral density or osteomalacia)
Unexplained neurological symptoms (particularly peripheral neuropathy or ataxia)
Persistent raised liver enzymes with unknown cause
Dental enamel defects
Down's syndrome
Turner syndrome

Why test?

The average time from symptom onset to correct diagnosis of coeliac disease is 13 years.²²

Untreated patients are more likely to develop long-lasting complications.²³

Coeliac disease is manageable, and symptoms can be resolved, by strictly adhering to a lifelong gluten-free diet.^11,24-29

What are the potential complications of untreated coeliac disease?²²

Central and peripheral system disorders
Iron deficiency anaemia
Secondary lactose intolerance
Gall bladder malfunction

Vitamin and mineral deficiencies
Early onset osteoporosis or osteopenia
Pancreatic insufficiency
Sub-fertility

Testing Confidence

Testing Increases Diagnostic Confidence

Adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis to 90 percent.^i,ii Conventionally, a diagnosis of allergic or autoimmune disease relies on the case history and a physical examination. However, adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis.^i,iiDiagnostic testing can also help to improve the patient’s quality of life and productivity, reduce costs associated with absenteeism, and optimize use of medication, in addition to decreasing unscheduled healthcare visits.^iii,iv

^{i. Duran-Tauleria E, Vignati G, Guedan MJ, et al. The utility of specific immunoglobulin E measurements in primary care. Allergy. 2004;59 (Suppl78):35-41.

ii. NiggemannB, Nilsson M, Friedrichs F. Paediatric allergy diagnosis in primary care is improved by in vitro allergen specific IgE testing. Pediatr Allergy Immunol. 2008;19:325-331

iii. Welsh N, et al. The Benefits of Specific Immunoglobulin E Testing in the Primary Care Setting. J Am Pharm Assoc. 2006;46:627.

iv. Szeinbach SL, Williams B, Muntendam P, et al. Identification of allergic disease among users of antihistamines. J Manag Care Pharm. 2004; 10 (3): 234-238}

Learn about gastrointestinal disease.

Gastrointestinal Disease

Learn more about testing.

Autoimmune Disease Testing Options

Test Coeliac: Which coeliac serology should I request?

The initial step toward a coeliac disease diagnosis is to test for coeliac-related antibodies.

Tissue transglutaminase IgA (IgA tTG) is the recommended first line test, together with total IgA to check for IgA deficiency. Most international guidelines, as well as NICE, recommend this. For this test to work, the patient must be consuming gluten.

Request testing through your local pathology lab. Your local pathology lab can advise if a specific algorithm needs to be followed based on the result and the age of the patient.

Treat Coeliac: How will identifying high-risk patients benefit clinical outcomes?

The early identification and appropriate management of patients with coeliac disease improves clinical outcomes including reducing the risk of cancer, reversing symptoms, and improving QoL*.^11,24-29

It is clinically effective and cost effective to use tTG IgA and DGP IgG to determine the need for endoscopy in patients with suspected coeliac disease.^11,24-29

Early diagnosis and treatment of coeliac disease can:^11,24-29

Decrease the risk of:

Delayed puberty
Some cancers
Complications in type 1 diabetes
Low birth weight babies

Improve:

Symptoms
The condition of the intestinal mucosa
Anemia
Diabetic control
Low bone mineral density, if made at young age
Persistent dermatitis herpetiformis skin lesions

Resolve:

Infertility
Menstrual problems
Spontaneous abortions

ACTIVELY TEST

Diagnosis and treatment of coeliac disease significantly reduces the costs of tests by 21 percent.²⁹

CASE-FIND IN YOUR PRACTICE

Diagnosis and treatment of coeliac disease sigificantly reduces referral to secondary care by 37 percent.

CONSIDER EVALUATING

Screening and then treating for coeliac disease is cost-effective in first-degree relatives, IBS patients and type 1 diabetes patients.¹¹

By diagnosing patients earlier, it is possible to reduce the unnecessary burden of coeliac disease.