Intended for healthcare professionals

Practice Easily Missed?

Coeliac disease

BMJ 2009; 338 doi: (Published 19 February 2009) Cite this as: BMJ 2009;338:a3058
  1. Roger Jones, Wolfson professor of general practice1,
  2. Sarah Sleet, chief executive2
  1. 1Department of General Practice and Primary Care, King’s College London, London SE11 6SP
  2. 2Coeliac UK, High Wycombe HP11 2HS
  1. Correspondence to: R Jones roger.jones{at}

    How common is it?

    • 1% prevalence in general Western populations (possibly higher in Western Europe and Scandinavia)

    • 3-6% prevalence in type 1 diabetes

    • 5-10% prevalence in first degree relatives

    • 10-15% prevalence in symptomatic iron deficiency anaemia

    • 3-6% prevalence in asymptomatic iron deficiency anaemia*

    • 1-3% prevalence in osteoporosis

    • *Pregnancy may unmask the effect of iron malabsorption, so testing pregnant women with moderate to severe anaemia is worth while

    Case scenario

    A 32 year old woman with fatigue and symptoms of irritable bowel syndrome has not responded to the usual treatment for the condition and has borderline iron deficiency anaemia. Her general practitioner requests tissue transglutaminase antibody (tTGA) testing, and the levels are found to be raised, leading to a diagnosis of coeliac disease.

    The finding of iron deficiency anaemia is not consistent with the diagnosis of a functional bowel disorder, and other possibilities needed to be considered, including inflammatory bowel disease, colorectal cancer, and coeliac disease. Although patients with coeliac disease typically present with diarrhoea, weight loss, and anaemia, they may also present with extraintestinal symptoms, particularly adults, and the disease is much more common than previously believed.1 Evidence is accumulating of substantial underdiagnosis in primary care, where several studies have suggested that as few as a quarter of patients with coeliac disease are recognised.2 3 4 …

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