{"id":3801,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/coeliac\/"},"modified":"2026-06-26T15:57:38","modified_gmt":"2026-06-26T14:57:38","slug":"coeliac","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gastrointestinal\/coeliac\/","title":{"rendered":"Coeliac"},"content":{"rendered":"\n<p class=\"has-alert-red-color has-text-color wp-block-paragraph\"><strong><u>Coeliac<\/u><\/strong><strong><u>&nbsp;Testing Issues<\/u><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">PLEASE NOTE UPDATED ADVICE (18th June 2026) gives a new tTG-IgA range of negative &lt;4.5U\/mL due to a change in method, but please always follow the interpretative comments attached to the result.<\/mark><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Background<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Coeliac disease is common (affecting approximately 1% of the general population).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The condition is more common in those with:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A positive family history<\/li>\n\n\n\n<li>Other autoimmune disease e.g. Type 1 Diabetes, thyroid disease<\/li>\n\n\n\n<li>Chromosomal abnormalities e.g. Down Syndrome<\/li>\n\n\n\n<li>Classical abdominal symptoms may be vague or absent.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Since January 2020 the management of Coeliac disease in NHS Lothian is dietician-led in line with Scottish Government Policy.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For advice on no-biopsy diagnosis for symptomatic adult patients please refer to the<strong>&nbsp;NHS Lothian Dietetic-Led&nbsp;Coeliac&nbsp;Pathway Flowchart (June 2026).<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/NHS-LOTHIAN-DIETETIC_5.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">NHS LOTHIAN DIETETIC LED COELIAC PATHWAY FLOWCHART JUNE 2026<\/a> <\/strong>outlines a summary of how Coeliac Disease is diagnosed and managed in NHS Lothian.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please remember that when referring patients <mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\"><strong>all patients must continue to eat adequate amounts of gluten until instructed otherwise by secondary care<\/strong>.<\/mark><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><strong>LAB &amp; GI TEAM, &amp; JB JUNE 2026<\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Patients with IgA tTG antibody &gt;10 units\/ml<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients with IgA tTG antibody 5-10 units\/ml on two occasions 3-months apart<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients with selective IgA deficiency and positive IgG tTG (&gt;10 units\/ml)<\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-276830d35b82a1cb10612fbb1140ff88 wp-block-paragraph\"><strong>All patients must continue to eat adequate amounts of gluten until instructed otherwise by secondary care <\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients can be provided with this information sheet on why and how they need to keep eating gluten until they have been told to stop by secondary care: <a href=\"https:\/\/appnhs24wp41a8c38064.blob.core.windows.net\/blobappnhs24wp41a8c38064\/wp-content\/uploads\/2023\/04\/diet-advice-when-being-tested-for-coeliac-disease-gluten-challenge.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>PIL Continuing to eat gluten when a diagnosis of coeliac disease is being considered<\/strong><\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Refer to Gastroenterology \u2013 Medical via SCI Gateway using the following pathways:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>RIE &gt;&gt; Gatroenterology \u2013 Medical &gt;&gt; LI Coeliac Referral<\/li>\n\n\n\n<li>SJH &gt;&gt; Gatroenterology \u2013 Medical &gt;&gt; LI Coeliac Referral<\/li>\n\n\n\n<li>WGH &gt;&gt; Gatroenterology \u2013 Medical &gt;&gt; LI Coeliac Referral<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Decision not to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Occasionally in Primary Care a decision may be made to <strong>not<\/strong> refer a patient who has IgA tTG antibody results indicative of a Coeliac diagnosis (e.g. patient moving to a different area \/ country). In these rare cases it is very helpful if Primary Care can inform the Coeliac service that despite the positive lab results a referral is <strong>not<\/strong> going to be made. This can be done by emailing the Coeliac Service inbox <a href=\"mailto:loth.coeliacservice@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">loth.coeliacservice@nhs.scot<\/a> <strong>(Email for professional use only)<\/strong><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to test:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Testing with coeliac serology is recommended for all patients presenting with:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Unexplained iron deficiency anaemia<\/li>\n\n\n\n<li>Prolonged fatigue<\/li>\n\n\n\n<li>Chronic or intermittent diarrhoea<\/li>\n\n\n\n<li>Symptoms suggestive of Irritable Bowel Syndrome<\/li>\n\n\n\n<li>Sudden or unexpected weight loss<\/li>\n\n\n\n<li>Failure to thrive or faltering growth in children<\/li>\n\n\n\n<li>Persistent or unexplained GI symptoms including nausea and\/or vomiting<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Testing should be considered in:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Unexplained recurrent aphthous mouth ulcers or angular stomatitis<\/li>\n\n\n\n<li>Unexplained persistently raised liver enzymes<\/li>\n\n\n\n<li>Persistent or unexplained constipation<\/li>\n\n\n\n<li>Unexplained reduced bone mineral density or metabolic bone disease e.g. osteomalacia<\/li>\n\n\n\n<li>Unexplained infertility<\/li>\n\n\n\n<li>Unexplained neurological symptoms, especially ataxia<\/li>\n\n\n\n<li>Lymphoma<\/li>\n\n\n\n<li>Sjogrens Syndrome<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-20349bba576692c2a6fcba34ed9e11d3 wp-block-paragraph\">&nbsp;<strong>All patients must continue to eat adequate amounts of gluten until instructed otherwise by secondary care<\/strong>. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients can be provided with this information sheet on why and how they need to keep eating gluten until they have been told to stop by secondary care: <a href=\"https:\/\/appnhs24wp41a8c38064.blob.core.windows.net\/blobappnhs24wp41a8c38064\/wp-content\/uploads\/2023\/04\/diet-advice-when-being-tested-for-coeliac-disease-gluten-challenge.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>PIL Continuing to eat gluten when a diagnosis of coeliac disease is being considered<\/strong><\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><strong><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/NHS-LOTHIAN-DIETETIC_5.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">NHS LOTHIAN DIETETIC LED COELIAC PATHWAY FLOWCHART JUNE 2026<\/a><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"\/files\/sites\/2\/NHS-LOTHIAN-COELIAC-SERVICE-REVIEW-27.04.20.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">NHS LOTHIAN COELIAC SERVICE REVIEW April 2020.pdf<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Lothian GFFS Gluten free information:&nbsp;<a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fservices.nhslothian.scot%2Fglutenfreefoodservice%2F&amp;data=05%7C02%7Crebecca.cheesbrough%40nhs.scot%7C734f133c9dfb466c3d8708dc3140aec7%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638439401073607503%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=tVMMXNV9sloEMKQuf04%2F%2BFVaypHciFGjkroOXYBng3Y%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>https:\/\/services.nhslothian.scot\/GlutenFreeFoodService\/Pages\/default.aspx<\/strong><\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Gluten Free Food Service Registration Form:&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/services.nhslothian.scot\/glutenfreefoodservice\/wp-content\/uploads\/sites\/22\/2022\/02\/GlutenFreeFoodRegistrationForm.pdf\" data-type=\"URL\" data-id=\"https:\/\/services.nhslothian.scot\/glutenfreefoodservice\/wp-content\/uploads\/sites\/22\/2022\/02\/GlutenFreeFoodRegistrationForm.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/services.nhslothian.scot\/GlutenFreeFoodService\/Documents\/GlutenFreeFoodRegistrationForm.pdf<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">NICE NG20:&nbsp;<a href=\"https:\/\/www.nice.org.uk\/guidance\/ng20\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nice.org.uk\/guidance\/ng20<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">NHS Inform:&nbsp;<a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fwww.nhsinform.scot%2Fillnesses-and-conditions%2Fstomach-liver-and-gastrointestinal-tract%2Fcoeliac-disease&amp;data=05%7C02%7Crebecca.cheesbrough%40nhs.scot%7C734f133c9dfb466c3d8708dc3140aec7%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638439401073612918%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&amp;sdata=iRggkBByWoZdqo9Pd1pybiUrbgLy%2BIBq3umXwzVLmIo%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/stomach-liver-and-gastrointestinal-tract\/coeliac-disease<\/strong><\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Coeliac UK:&nbsp;<a href=\"https:\/\/www.coeliac.org.uk\/information-and-support\/coeliac-disease\/about-coeliac-disease\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.coeliac.org.uk\/information-and-support\/coeliac-disease\/about-coeliac-disease\/<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Coeliac&nbsp;Testing Issues PLEASE NOTE UPDATED ADVICE (18th June 2026) gives a new tTG-IgA range of negative &lt;4.5U\/mL due to a change in method, but please always follow the interpretative comments attached to the result. Background Coeliac disease is common (affecting approximately 1% of the general population). The condition is more common in those with: Since<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3955,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[197],"class_list":["post-3801","page","type-page","status-publish","hentry","category-coeliac"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/gastrointestinal\/coeliac\/\" rel=\"tag\">Coeliac<\/a>","rttpg_excerpt":"Coeliac&nbsp;Testing Issues PLEASE NOTE UPDATED ADVICE (18th June 2026) gives a new tTG-IgA range of negative &lt;4.5U\/mL due to a change in method, but please always follow the interpretative comments attached to the result. Background Coeliac disease is common (affecting approximately 1% of the general population). The condition is more common in those with: Since","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3801","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3801"}],"version-history":[{"count":20,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3801\/revisions"}],"predecessor-version":[{"id":28599,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3801\/revisions\/28599"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3955"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3801"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3801"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}