Intended for healthcare professionals

Practice Guidelines

Recognition, assessment, and management of coeliac disease: summary of updated NICE guidance

BMJ 2015; 351 doi: (Published 02 September 2015) Cite this as: BMJ 2015;351:h4513
  1. Laura Downey, technical analyst1,
  2. Rachel Houten, technical analyst (health economics)1,
  3. Simon Murch, paediatric gastroenterologist1,
  4. Damien Longson, guideline chair1
  5. On behalf of the Guideline Development Group
  1. 1National institute for Health and Care Excellence, Manchester M1 4BT, UK
  1. Correspondence to: L Downey laura.downey{at}

The bottom line

  • Offer testing for coeliac disease to people with unexplained gastrointestinal and some non-gastrointestinal symptoms, including fatigue, anaemia, or faltering growth in children

  • Total IgA and IgA tissue transglutaminase antibodies (tTG) should be first choice tests in adults and children; if IgA tTG is weakly positive in adults, test for IgA endomysial antibodies; any positive IgA tTG result in children should prompt further investigation

  • A delayed diagnosis can lead to ill health and serious long term complications, such as osteoporosis, infertility, and small bowel cancer

  • A healthcare professional with specialist knowledge of coeliac disease should inform people about information sources and the importance of the gluten-free diet, which may include gluten-free oats

How patients were involved in the creation of this article

Committee members involved in this guideline included lay members who contributed to the formulation of the recommendations summarised here.

Coeliac disease is a common autoimmune condition, in which the ingestion of gluten (present in wheat, barley, and rye) activates an abnormal immune response, leading to chronic inflammation of the small intestine and malabsorption of nutrients. It affects about 1% of the UK population.1 Coeliac disease can present with a wide range of clinical features, although some people initially experience few or no symptoms. Treatment involves a lifelong gluten-free diet because untreated disease can lead to serious long term health complications. First degree relatives of a person with the disease and people with other conditions (including type 1 diabetes and Down’s syndrome) are at higher risk of having coeliac disease. This article summarises the recently updated recommendations from the National Institute for Health and Care Excellence (NICE) on the recognition, assessment, and management of coeliac disease.2


NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience …

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