Clinical Review

Coeliac disease

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g1561 (Published 03 March 2014) Cite this as: BMJ 2014;348:g1561
  1. Peter D Mooney, clinical research fellow gastroenterology1,
  2. Marios Hadjivassiliou, professor of neurology and NHS consultant2,
  3. David S Sanders, professor of gastroenterology and NHS consultant1
  1. 1Regional Gastrointestinal and Liver Unit, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
  2. 2Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
  1. Correspondence to: P D Mooney peter.mooney{at}sth.nhs.uk

Summary points

  • Adult coeliac disease is a common autoimmune condition with an estimated prevalence of 1%

  • Test for coeliac disease in patients with unexplained anaemia, weight loss, diarrhoea, or gastrointestinal symptoms, particularly irritable bowel syndrome, and in first degree relatives of index cases

  • Confirm the diagnosis with duodenal biopsy in all adult patients

  • Treatment with a lifelong strict gluten-free diet is currently the only treatment of known effectiveness

  • Patients should have access to an expert dietitian for advice on a gluten-free diet and for assessment of adherence if symptoms persist on institution of the diet

  • Regular follow-up is necessary to assess adherence and micronutrient deficiency

Coeliac disease is a common autoimmune condition characterised by a heightened immunological response to ingested gluten, with estimated prevalence rates in adults of 0.2-1% in the United States and Europe. Contemporary studies suggest that the prevalence of this disease is increasing.3 4 5 Meta-analyses have shown that for every patient identified as having coeliac disease seven to eight remain undiagnosed. Here, we will summarise recent evidence on how the investigation and diagnosis of coeliac disease can be improved and also provide an evidence based approach to managing patients with newly diagnosed coeliac disease and those who do not respond to a gluten-free diet as expected. Evidence is taken from meta-analyses, systematic reviews, and randomised controlled trials where possible.

Sources and selection criteria

We searched Medline and the Cochrane Database of Systematic Reviews with the search terms “coeliac disease” or “celiac disease”. Studies included those in adult and paediatric populations but preference was given to adult studies in the past five years. We focused on meta-analyses and systematic reviews where possible.

Who gets coeliac disease?

In the past coeliac disease was considered to be a disease that affects white populations only, but it is now clear that coeliac disease is a global problem. Clinicians in …

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