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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

Coeliac Disease

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?


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,ii Diagnostic 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.

Learn more about testing.



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


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


  • Infertility
  • Menstrual problems
  • Spontaneous abortions


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

Audit your practice


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



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.

  1. Muray JA, et al. Clin Gastroenterol Hepatol 2003 1(1): 13-27.
  2. Cristofori F, et al. JAMA Pediatrics 2014:168;555-560.
  3. El-Sahly M, et al. Nutr J 2015;14:92.
  4. Campisi G, et al. Dig Liver Dis 2008;40(2):104-107.
  5. Ludvigsson J F et al. J Am Med Inform Assoc 2013: e2; e306-e310
  6. Lasa JS, et al. Arq Gastroenterol 2014;51:144-50.
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  9. Singh P, et al. Am J Gastroenterol 2015;110:1539-1548.
  10. West J, et al. Am J Gastroenterol 2014;109:757-768.
  11. National Institute for Health and Care Excellence. Coeliac Disease –Recognition, assessment and management (NG20). 2015. London: National Institute for Health and Care Excellence.
  12. National Institute for Health and Care Excellence. Irritable bowel syndrome in adults: diagnosis and management (CG61). 2015. London: National Institute for Health and Care Excellence.
  13. Ludvigsson JF, et al. Gut 2014;63(8):1210-1228.
  14. World Gastroenterology Organisation. IBS: A global perspective. Available from http://www.worldgastroenterology.org/guidelines/global-guidelines/irritable-bowel-syndrome-ibs/irritable-bowel-syndrome-ibs-english; last accessed May 2016.
  15. American Diabetes Association. Diabetes Care 2015;38 (Suppl. 1): S1–S2.
  16. American Diabetes Association. Diabetes Care 2015;38 (Suppl. 1):S17–S19.
  17. International Diabetes Federation. Global IDF/ISPAD Guideline for Diabetes in Childhood and adolescence. 2011. Available from http://www.idf.org/sites/default/files/Diabetes-in-Childhood-and-Adolescence-Guidelines.pdf; last accessed May 2016.
  18. Scottish Intercollegiate Guidelines Network. Management of Diabetes (116). 2014.
  19. Husby S, et al. JPGN 2012;54:136-160.
  20. Rubio-Tapia A, et al. Am J Gastroenterol 2013;108@656-676.
  21. World Gastroenterology Organisation. Coeliac disease: Global guidelines. Available from http://www.worldgastroenterology.org/guidelines/global-guidelines/celiac-disease/celiac-disease-english; last accessed July 2018.
  22. Gray AM and Papanicolas N. BMC Health Services Research 2010; 10:105.
  23. Celiac Disease Foundation: Celiac Disease Symptoms. Available from https://celiac.org/celiac-disease/understanding-celiac-disease-2/what-is-celiac-disease/24477; Last accessed July 2018.
  24. Elfström P, et al. Aliment Pharmacol Ther 2014;40(10):1123-32.
  25. Grace-Farfaglia, P. Nutrients 2015;7:3347-3369.
  26. Murch S, et al. Arch Dis Child 2013;98:806-811.
  27. Shar S and Leffler D. Womens Health (Lond Engl) 2010;6(5):753-766.
  28. Smedby K, et al. Gut 2005;54:54-59.
  29. Violato M, et al. PLoS One 2012;7(7):e41308.