Simpler diagnostic process for adults with suspected coeliac disease

doctor test coeliac disease

7 July 2020

Interim guidance from the British Society of Gastroenterology, pending the publication of its new Coeliac Guidelines in 2021, states that some adults with suspected coeliac disease can now be diagnosed based on blood test results alone, cutting out the long wait for an endoscopy with biopsy.

Diagnosis of coeliac disease in adults is usually a two step process, a blood test to look for antibodies followed by an endoscopy with biopsy to look for damage to the intestine. Early in the coronavirus pandemic, the BSG recommended that non emergency endoscopies should be paused to protect NHS staff and patients from coronavirus transmission. This meant that many people with suspected coeliac disease have been unable to have an endoscopy as part of their diagnosis.

The interim guidance published due to the impact of Covid-19 on endoscopy waiting lists, suggests that a no biopsy diagnosis can be used for adults under 55 years of age with symptoms of coeliac disease who:

  • don’t need an endoscopy to rule out other conditions
  • have antibody levels (IgA tissue transglutaminase) at least 10 times the upper limit of normal
  • have a second positive antibody blood test (endomysial antibodies (EMA) or tissue transglutaminase if EMA isn’t available).

A GP can request the initial antibody blood test but the decision about whether an endoscopy and biopsy is needed, and the final diagnosis of coeliac disease, should be made by a gastroenterologist. The impact of this new diagnosis pathway will be closely monitored, and data is being collected to assess the impact of this new approach for adults. For children, since 2013, guidelines have recommend a no biopsy diagnosis for some children.

These guidelines are good news for those who meet the criteria for a no biopsy diagnosis who will be able to start to feel better sooner on a gluten free diet, the only treatment for coeliac disease.

Read the full press release here.


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