Background
Coeliac disease is common (affecting approximately 1% of the general population).
The condition is more common in those with:
- A positive family history
- Other autoimmune disease e.g. Type 1 Diabetes, thyroid disease
- Chromosomal abnormalities e.g. Down Syndrome
- Classical abdominal symptoms may be vague or absent.
From January 2020 the management of coeliac disease in Lothian has become dietician-led in line with Scottish Government Policy.
With the advent of COVID-19 Lothian has adopted a no-biopsy diagnosis for symptomatic adult patients with IgA tTG of 50 and over on two occasions, with the approval of the British Society of Gastroenterology. In Paediatrics, a no-biopsy strategy has been in place for a number of years.
Who to refer:
Patients with IgA tTG antibody >10 units/ml
Symptomatic patients with IgA tTG antibody 5-10 units/ml
Asymptomatic patients (eg those with family history) and IgA tTG 5-10 units/ml on two occasions 3-months apart whilst continuing to eat gluten.
Patients with selective IgA deficiency and positive IgG tTG (>10 units/ml)
All patients must continue to eat adequate amounts of gluten until instructed otherwise by secondary care diet-advice-when-being-tested-for-coeliac-disease-gluten-challenge.pdf (windows.net)
How to refer:
To medical gastroenterology using Sci-Gateway.
Whom to test:
Testing with coeliac serology is recommended for all patients presenting with:
- Unexplained iron deficiency anaemia
- Prolonged fatigue
- Chronic or intermittent diarrhoea
- Symptoms suggestive of Irritable Bowel Syndrome
- Sudden or unexpected weight loss
- Failure to thrive or faltering growth in children
- Persistent or unexplained GI symptoms including nausea and/or vomiting
Testing should be considered in:
- Unexplained recurrent aphthous mouth ulcers or angular stomatitis
- Unexplained persistently raised liver enzymes
- Persistent or unexplained constipation
- Unexplained reduced bone mineral density or metabolic bone disease e.g. osteomalacia
- Unexplained infertility
- Unexplained neurological symptoms, especially ataxia
- Lymphoma
- Sjogrens Syndrome
A positive serological test for Coeliac Disease depends upon the interaction between dietary gluten and the small intestinal mucosa. Thus, if gluten is withdrawn from the diet, the tests become unreliable as a diagnostic tool.
NHS LOTHIAN COELIAC SERVICE REVIEW 27.04.20.pdf
Gluten Free Food Service Registration Form: https://services.nhslothian.scot/GlutenFreeFoodService/Documents/GlutenFreeFoodRegistrationForm.pdf
NICE NG20: https://www.nice.org.uk/guidance/ng20
NHS Choices Coeliac Disease: https://www.nhs.uk/conditions/coeliac-disease/
Coeliac UK: https://www.coeliac.org.uk/information-and-support/coeliac-disease/about-coeliac-disease/
