Coeliac disease: recognition and assessment of coeliac disease continued

Care pathway

• Important:
• do not use serological testing for coeliac disease in infants before gluten has been introduced to the diet
• all tests should be undertaken in laboratories with
• clinical pathology accreditation (CPA)
• do not use IgA or IgG anti-gliadin antibody (AGA) tests in the diagnosis of coeliac disease
• do not use HLA DQ2/DQ8 testing in the initial diagnosis of coeliac
• disease (However, its high negative predictive value may be of use to gastrointestinal specialists in specific clinical situations)
• do not use self-tests and/or point of care tests for coeliac disease as a substitute for laboratory-based testing

Dietary considerations

• Inform people (and their parents or carers as appropriate) that:
• testing (serology and biopsy if required) is accurate only if they follow a gluten-containing diet
• when following a gluten-containing diet they should eat some gluten in more than one meal every day for at least 6 weeks before testing
• they should not start a gluten-free diet until diagnosis is confirmed by intestinal biopsy (even if a self-test or other serological test is positive)

Other information before serological testing

• Inform people who are considering, or who have undertaken, self-testing for coeliac disease that any result from self-testing needs to be discussed with a healthcare professional and confirmed by laboratory-based tests

• Before seeking consent to take blood for serological tests, explain:
• what coeliac disease is
• that serological tests do not diagnose coeliac disease, but indicate whether further testing is needed
• the implications of a positive test (including referral for intestinal biopsy and implications for other family members)
• the implications of a negative test (that coeliac disease is unlikely but it could be present or arise in the future)

• Inform people (and their parents or carers as appropriate) that a delayed diagnosis of coeliac disease, or undiagnosed coeliac disease, can result in:
• continuing ill health
• long-term complications, including osteoporosis and increased fracture risk, unfavourable pregnancy outcomes and a modest increased risk of intestinal malignancy
• growth failure, delayed puberty and dental problems (in children)

Coeliac disease: recognition and assessment of coeliac disease continued

Care pathway

full guideline available from…
National Institute for Health and Clinical Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA
guidance.nice.org.uk/CG86

National Institute for Health and Clinical Excellence. Coeliac disease: recognition and assessment of coeliac disease. May 2009