Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles.
Coeliac disease is an unusual disease in that the principal management tool is the avoidance of a particular element of food, in this case gluten. In the short term, someone with the condition well-managed develops abdominal pain that can last for a day or two. Continuous ingestion of very small amounts of gluten will lead to malabsorption, and an increased risk of lymphoma. The prevalence in western Europe is about 1%, of which at least 95% is undiagnosed. A typical GP will have a handful of patients, many of whom will choose not to request gluten-free food on prescription. The "bureaucratic burden" is therefore much less than for many patients with multimorbidity, especially as the patient can do most of the research - the Coeliac Society has a lot of useful resources.
We should only be prescribing gluten-free foods for patients who have been properly diagnosed by a gastroenterologist, so it is not just indulging a fad. Not all gluten-free food in supermarkets is good quality, and the shops in poorer and more isolated areas have a very limited selection. Other countries, such as Italy, provide vouchers to allow patients with coeliac disease to but gluten-free foods in supermarkets, and this would be a solution well worth investigating. What should not be an option is GP and CCGs refusing to prescribe treatment for a serious disease without a national debate and uniform prescribing policies across the country.
Conflict of interest: a close family member has coeliac disease.