Coeliac disease affects around 1% of the general population, but most cases are unrecognised and diagnosis is often delayed considerably.1 2 This is surprising, given how common the disease is and how serious its effects can be.1 3 4 Several possible reasons exist for this delay; the most important is that most patients with coeliac disease do not have typical symptoms of malabsorption. Even if these symptoms are present their non-specific nature may not trigger diagnostic suspicion of coeliac disease. Other atypical presentations can occur, especially in older patients,5 and the disease may even be seen in obese people.6

In this week's BMJ, Hopper and colleagues report a validated clinical prediction rule to determine an effective diagnostic method of detecting all cases of coeliac disease in people referred for gastroscopy. People with positive tissue transglutaminase antibodies and “low risk symptoms,” as well as those with the high risk symptoms of diarrhoea, weight loss, and anaemia, were investigated with duodenal biopsy, while those with a negative antibody result and low risk symptoms were …