Intended for healthcare professionals

Letters Fatigue in primary care

Test for coeliac disease first?

BMJ 2010; 341 doi: (Published 02 November 2010) Cite this as: BMJ 2010;341:c5161
  1. David S Sanders, professor of gastroenterology1,
  2. Kate E Evans, clinical fellow in gastroenterology1,
  3. Marios Hadjivassiliou, consultant neurologist1
  1. 1University of Sheffield, Sheffield, UK
  1. david.sanders{at}

In their overview of investigating fatigue in primary care, Hamilton and colleagues conclude that the prevalence of fatigue in patients with coeliac disease is unknown and that coeliac serology should be a second line test.1 However, a screening study of 1200 primary care patients found that the prevalence of fatigue or being tired all the time (using primary care criteria) was 7.7% (92/1200) and the prevalence of coeliac disease in the fatigue group was 3.3% (3/92).2 Furthermore, two of the three patients reported fatigue as the sole symptom.

Coeliac disease is common in adults (1%) and frequently unrecognised; patients are often seen on many occasions in both primary and secondary care.3 The serological test is inexpensive (£20 per patient), and early detection is cost effective.4

Time for coeliac serology to be a first line test in patients with fatigue?


Cite this as: BMJ 2010;341:c5161


  • Competing interests: None declared.


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