• Autoimmune condition in which dietary proteins (glutens), activate an abnormal mucosal response with chronic inflammation and damage (villous atrophy) to the lining of the small intestine. AKA gluten-sensitive enteropathy, coeliac sprue, non-tropical sprue.≠ 'gluten intolerance'. 

Clinical

• Can present with a wide range of clinical features, both GI (indigestion, diarrhoea, abdominal pain, bloating, and constipation) and non-GI (such as fatigue, anaemia, dermatitis herpetiformis, osteoporosis, fertility problems, short stature, delayed puberty, and peripheral neuropathy)

Diagnosis

• Exclude – initially with an antibody screen. IgA transglutimase antibody is the test of choice with specificity and sensitivity at least as good as endomysial antibody. 

• Any test is accurate only if a gluten‑containing diet is eaten during the diagnostic process. Therefore patients should be advised not to start a gluten‑free diet until diagnosis is confirmed by a specialist, and to continue on a normal diet (containing gluten) with some gluten in more than one meal every day for at least six weeks before testing

Resources

• Coeliac disease (NHS Choices)

• Coeliac disease (CKS)

• Coeliac disease: recognition, assessment and management (NICE, 2015)

• Coeliac disease (Medicines complete, 2016)

• Coeliac UK (coeliac.org.uk)

MCQs

A three-year-old boy is noted to have poor weight gain. His mother has coeliac disease and asks about testing her son to see if he also needs a gluten-free diet.

1. It must be carried out before the introduction of gluten into the diet

2. It is valid even if gluten has only been included in the diet on one or two occasions in the past four weeks before testing

3. It may only be valid if gluten has been taken daily in at least two meals a day for six weeks before testing

4. It may only be valid if gluten has been taken daily for at least three months before testing

5. It is not valid in children