NICE calls for wider use of blood tests to diagnose coeliac disease

BMJ 2016; 355 doi: (Published 20 October 2016) Cite this as: BMJ 2016;355:i5660
  1. Jacqui Wise
  1. London

GPs should offer a blood test to anyone who has symptoms of coeliac disease or who is at increased risk of the condition, the National Institute for Health and Care Excellence (NICE) has recommended.1 Doctors should ensure that people have been following a gluten containing diet for at least six weeks before the test.

Coeliac disease affects around 530 000 people in England but is currently underdiagnosed, NICE said. If coeliac disease is not treated it can cause long term health problems such as osteoporosis, ulcerative jejunitis, and intestinal lymphoma.

The NICE quality standard said that a serological test should be offered to anyone with any of the following symptoms:

  • Persistent unexplained abdominal or gastrointestinal symptoms

  • Faltering growth

  • Prolonged fatigue

  • 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.

Testing should also be offered to any adults who met the diagnostic criteria for irritable bowel syndrome and to any first degree relatives of people newly diagnosed with coeliac disease.

People who had a positive serological test for coeliac disease should be referred to a specialist and advised to continue with a gluten containing diet until the diagnosis was confirmed. An endoscopic intestinal biopsy to confirm a diagnosis of coeliac disease should be carried out within six weeks of referral, NICE said.

Once a diagnosis was confirmed the patient should discuss with a dietician how to follow a gluten free diet. People with coeliac disease should have an annual review to check their symptoms and diet, and to find out if they need further advice or assessment

Gillian Leng, deputy chief executive and director of health and social care at NICE, said: “If coeliac disease goes undiagnosed, people not only have a poor quality of life; they may go on to suffer other serious complications, such as osteoporosis or cancer. Our quality standard calls for a wider use of blood tests for anyone who shows symptoms or those that are at increased risk as soon as possible to rule out the condition.”


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