Management guidelines

There are a number of guidelines available on the management of people with coeliac diseaseA condition where a person is unable to eat gluten as it makes their body attack itself. for both adults and children.

Adults

The British Society of Gastroenterology (BSGBritish Society of Gastroenterology - an organisation focused on the promotion of gastroenterology within the United Kingdom, with a membership drawn from physicians, surgeons, pathologists, radiologists, scientists, nurses, dietitians, and others interested in the field. The BSG is a registered charity.) has recently produced a review paper on the management of coeliac disease in adults.  This is not a published guideline but can be viewed on the BSG website.

• British Society of Gastroenterology (BSG, 2010) The management of adults with coeliac disease.

Other management guidelines include:

• Primary Care Society of Gastroenterology (PCSG, 2006) The Management of adults with coeliac disease in primary care.

This document supersedes previous PCSG guidelines on Decision points in the management of adult coeliac disease in primary care (2002) and Follow-up care of adult coeliac disease (2001).

• CREST (2006) Guidelines for the diagnosis and management of coeliac disease in adults.  These guidelines are specific to Northern Ireland. As of August 2007, CREST is now part of the Guidelines and Audit Implementation Network (GAIN).

Children

• Coeliac working group of the British Society of Paediatric Gastroenterology Hepatology and Nutrition (BSPGHAN, 2006). Guideline for the diagnosis and management of coeliac disease in children.

The BSPGHAN guidelines were derived from the available evidence (including the North American Paediatric guidelines document) after discussion and debate between members of the Managed Clinical Network for Paediatric Gastroenterology. It represents the views of the network members only.

Dermatitis HerpetiformisUsually shortened to DH, this is a form of coeliac disease where the skin is affected with small blisters.

• Caproni M, Antiga E, Melani L, Fabbri P. (2009) Guidelines for the diagnosis and treatment of DH. Journal of European Academy of Dermatology and Venereology 23 (6): 633 – 638

OsteoporosisA condition where your bones lose bone mass and become brittle.

• British Society of Gastroenterology (BSG, 2007) Guidelines for osteoporosis in coeliac disease and inflammatory bowel disease

More information on osteoporosis can be found on the management of osteoporosis page.

Prescriptions

Guidelines are available to assist GPsGeneral Practitioner, or local doctor, dietitians, pharmacists and practice nurses in the decision making process when prescribing gluten-freeWhen a food has less than 20 parts per million (ppm) of gluten so it is safe for people with coeliac disease to eat. foods.

• GlutenA protein that is found in the cereals wheat, barley and rye. -free foods: a prescribing guide was developed by the British Dietetic Association (BDABritish Dietetic Association - the professional association for dietitians in the UK.), the Primary Care Society for Gastroenterology (PCSG), and Coeliac UK in 2004.

More information on prescriptions can be found on our prescriptions page.

Diagnosis

There is a National Institute for Health and Clinical Excellence (NICE) guideline on the recognition and assessment of coeliac disease which was published in May 2009.  This provides information on the clinical signs, symptoms and presentation of coeliac disease.  There is currently no NICE guideline on the management of coeliac disease.

Other NICE guidelines that mention coeliac disease include:

• Irritable bowel syndrome in adults. Diagnosis and management of irritable bowel syndrome in primary care. This guideline was published in February 2008.  It recommends that people who meet the IBSIrritable bowel syndrome - a common but poorly understood chronic (long-term) condition where the normal functions of the bowel are disrupted diagnostic criteria should have antibody testing (tissue transglutaminase (tTGTissue Transglutaminase - an antibody that is measured in the blood as part of the diagnosis process for coeliac disease. Depending on the laboratory performing the test, one or more antibodies may be measured (see Endomysial antibody)) and/or Endomysial antibodiesExist in the blood and are used by the immune system to attack viruses or bacteria. (EMAEndomysial antibody - an antibody that is measured in the blood as part of the diagnosis process for coeliac disease. Depending on the laboratory performing the test, one or more antibodies may be measured (see Tissue Transglutaminase))) to exclude a diagnosis of coeliac disease.
• Constipation in children and young people. Diagnosis and management of idiopathic childhood constipation in primary and secondary care.  This guideline was published in May 2010.  It recommends testing for coeliac disease in children with evidence of intractable constipation and/or faltering growth.

The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHANEuropean Society of Paediatric Gastroenterology, Hepatology and Nutrition - is a professional and scientific society which seeks to influence the standards of care for patients. Sets standards for education, training and clinical excellence within Europe.) guidelines for the diagnosis of coeliac disease are currently being updated.

Dietitian led clinics are becoming a more popular way of managing people with coeliac disease. For more information please see our page on setting up a dietitian led coeliac clinic.