Recognition and assessment of coeliac disease
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Recognition and assessment of coeliac disease. Implementing NICE guidance. 2009. NICE clinical guideline 86. What this presentation covers. Background Scope Recommendations Costs and savings Discussion Find out more. Background.

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Recognition and assessment of coeliac disease

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Recognition and assessment of coeliac disease

Implementing NICE guidance


NICE clinical guideline 86

What this presentation covers




Costs and savings


Find out more


  • Coeliac disease is a state of heightened immune response to ingested gluten in genetically susceptible people

  • It is believed to be present in up to 1 in 100 of the population

  • It often goes unrecognised and is consequentlyunder-diagnosed. Only 10–15% of people with the condition are thought to be clinically diagnosed and some people have no symptoms

  • There is some uncertainty about which serological tests are most suitable for use in the diagnostic process


  • The guideline covers recognition, assessment and investigation of people who present with gastrointestinal or non-gastrointestinal symptoms or signs that are suggestive of coeliac disease

  • The target population is adults and children with symptoms and/or signs that suggest coeliac disease


The key areas for recommendations are:

  • When to offer testing

  • Dietary considerations before testing

  • Other information before serological testing

  • Serological tests

  • After serological tests

When to offer testing

  • Offer serological testing to people with any of the symptoms, signs and conditions associated with coeliac disease

  • Consider offering serological testing to people with conditions that are sometimes associated withcoeliac disease

Dietary considerations before testing

Inform people that:

  • testing 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

Other information before serological testing

  • Inform people that any result from self-testing needs to be discussed with a healthcare professional and confirmed by laboratory results

  • Explain what coeliac disease is, the purpose of serological tests and what the results mean, and the implications of a positive or negative test

  • Inform people that a delayed diagnosis can result in continuing ill health and long-term complications, and in children can result in growth problems

Serological tests: 1

  • Tests should be undertaken in laboratories with clinical pathology accreditation

  • Do not use immunoglobulin G (IgG) and immunoglobulin A (IgA) anti-gliadin antibody (AGA) tests

  • Do not use self-tests and/or point-of-care tests for coeliac disease as a substitute for laboratory-based testing

  • Do not use human leukocyte antigen (HLA) DQ2/DQ8 testing in the initial diagnosis of coeliac disease

Serological tests: 2

Laboratories should use tests in the following order:

  • IgA tissue transglutaminase (tTGA) as the first choice

  • If tTGA test is equivocal, use IgA endomysial antibodies (EMA) test

  • If serology is negative, check for IgA deficiency

  • If IgA deficiency is confirmed, use IgG tTGA and/or IgG EMA serological tests

    Values and interpretation of results, and recommended actions should be communicated clearly

After serological tests

Offer referral to a gastrointestinal specialist for intestinal

biopsy, to confirm or exclude coeliac disease, to

people with:

  • positive serological results

  • negative serological results but with continuing clinical suspicion

Costs per 100,000 population


  • How do we improve recognition of coeliac disease in people presenting with the signs, symptoms and conditions associated with coeliac disease?

  • What serological tests and testing strategies do we use in the diagnostic process for coeliac disease and are these the ones recommended in this guideline?

  • How do we ensure that patients are given all the necessary information on:

    • dietary considerations before testing for coeliac disease

    • the diagnostic process?

Find out more

Visit for:

  • the guideline

  • the quick reference guide

  • ‘Understanding NICE guidance’

  • costing report and template

  • audit support

  • commissioning factsheet

  • guide to resources

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