Intended for healthcare professionals

Practice Guidelines

Recognition and assessment of coeliac disease in children and adults: summary of NICE guidance

BMJ 2009; 338 doi: (Published 27 May 2009) Cite this as: BMJ 2009;338:b1684
  1. Roberta Richey, technical analyst1,
  2. Peter Howdle, professor of clinical medicine2,
  3. Elizabeth Shaw, technical adviser1,
  4. Tim Stokes, associate director1
  5. on behalf of the Guideline Development Group
  1. 1Centre for Clinical Practice (Short Clinical Guidelines), National Institute for Health and Clinical Excellence, Manchester M1 4BD
  2. 2Leeds Institute of Molecular Medicine, St James’s University Hospital, Leeds LS9 7TF
  1. Correspondence to: P Howdle p.d.howdle{at}

    Why read this summary?

    Coeliac disease is an autoimmune condition that can be diagnosed at any age. Although it has been traditionally associated with mainly gastrointestinal signs and symptoms, its non-gastrointestinal features have been increasingly recognised.

    Given its varied clinical manifestations and the historical belief that it is relatively uncommon,1 2 concern has been raised that coeliac disease—and its possible long term consequences—is being underdiagnosed. It has also been shown to be more prevalent in people with other autoimmune conditions.3 This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the recognition and assessment of coeliac disease.4


    NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

    Who should be offered serological testing for coeliac disease?

    • Offer testing to children and adults with any of the following signs and symptoms:

      • -Chronic or intermittent diarrhoea

      • -Failure to thrive or faltering growth (in children)

      • -Persistent and unexplained gastrointestinal symptoms including nausea or vomiting

      • -Prolonged fatigue

      • -Recurrent abdominal pain, cramping, or distension

      • -Sudden or unexpected weight loss

      • -Unexplained iron deficiency anaemia or other unspecified anaemia.

    [Based on moderate quality evidence from cohort studies]

    • Offer testing to children and adults with any of the following conditions:

      • -Autoimmune thyroid disease

      • -Dermatitis herpetiformis

      • -Irritable bowel syndrome

      • -Type 1 diabetes.

    • Offer testing to children and adults …

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