GPAtlas🧭 When to suspect
Coeliac disease is a lifelong autoimmune enteropathy triggered by dietary gluten (the storage protein of wheat, barley and rye) in genetically susceptible people.
The immune response causes villous atrophy of the small bowel and consequent malabsorption.
Coeliac disease affects roughly 1 in 100 of the UK population, yet around two-thirds remain undiagnosed, largely because the presentation is so variable.
The clinical challenge is that coeliac disease is a true “clinical chameleon”. Far fewer patients now present with classic steatorrhoea and weight loss.
Many present with:
• Unexplained iron-deficiency anaemia.
• An IBS-type picture.
• Persistent fatigue.
Others are picked up while screening for an associated condition. Coeliac disease can present at any age once gluten has been introduced into the diet.
Keep a low threshold for serological testing in the right groups, and remember that any test is only valid while the patient is still eating gluten.
| Offer serological testing |
|---|
|
• Persistent unexplained abdominal or gastrointestinal (GI) symptoms • Faltering growth (children) • Prolonged fatigue or 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 |
| Consider serological testing |
|---|
|
• Metabolic bone disorder (reduced bone density or osteomalacia) • Unexplained neurological symptoms – peripheral neuropathy or ataxia • Unexplained subfertility or recurrent miscarriage • Persistently raised liver enzymes of unknown cause • Dental enamel defects |
|
• Down’s syndrome • Turner syndrome • Have a low threshold to re-test any of these groups if new or persistent symptoms develop |
Source: NICE NG20 · British Society of Gastroenterology
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