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Coeliac disease is caused by a reaction of the immune system to gluten. The symptoms include:

• bloating
• diarrhoea
• wind
• constipation
• nausea
• tiredness
• mouth ulcers
• sudden weight loss
• anaemia
• osteoporosis.

Once diagnosed, it is treated by following a gluten free diet. Dermatitis herpetiformis is the skin manifestation of coeliac disease.

The first test for coeliac disease is a blood test done by your GP that looks for antibodies that the body makes in response to eating gluten. If the blood test is positive, your GP will then refer you to a hospital specialist (gastroenterologist) for an endoscopy with biopsy.

In some cases, an endoscopy might not be needed to diagnose coeliac disease. Guidelines published in June 2020 in response to the Covid-19 pandemic recommend that some adults can be diagnosed without the need for a biopsy if they:

• are 55 years or younger
• don't need an endoscopy to rule out another condition
• have symptoms of coeliac disease
• have very high antibody levels (if IgA tTG is at least 10 times the upper limit of normal)
• and have a second positive antibody blood test (EMA or IgA tTG if EMA is not available)

If you have any concerns about testing, the best thing to do is to talk with your healthcare team.

You can also take Coeliac UK’s online assessment to find out if your symptoms may be caused by coeliac disease.

The National Institute for Health and Care Excellence (NICE) published a guideline on the recognition, assessment and management of coeliac disease in children and adults in England and Wales in September 2015.  The British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) in collaboration with Coeliac UK published guidelines on the diagnosis and management of coeliac disease in children in 2013. These guidelines may be applied in Scotland, as the Scottish Intercollegiate Guidelines Network (SIGN) who develop guidelines for the National Health Service (NHS) in Scotland, have not yet produced guidelines on coeliac disease.

We have further information on diagnosis on our website.

Information on the management of coeliac disease, including new patient appointment and follow up appointment checklists can be found on the Coeliac UK website. You can also refer patients to Coeliac UK for further information and support on the gluten free diet and access to resources. Find out more about the benefits for your patients of joining Coeliac UK.

There is a National Institute of Health and Clinical Excellence (NICE) guideline on recognition, assessment and management of coeliac disease for healthcare professionals in Primary and Secondary care. The guideline outlines the symptoms and patients at risk of coeliac disease and also the appropriate blood tests and the exact process to be completed in order to identify patients with coeliac disease.

The British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) in collaboration with Coeliac UK published guidelines on the diagnosis of coeliac disease in children in 2013. These guidelines suggest that in some cases in children with symptoms and whose blood tests show a high level of antibodies and who have the genes present for coeliac disease, a biopsy may not be needed to confirm diagnosis. We have further information on the diagnosis of coeliac disease on our website.

Coeliac disease does run in families but not in a predictable way. Around one in ten close relatives of people with coeliac disease (for example, father, mother, son, daughter) will be at risk of coeliac disease.

So if you have a relation with coeliac disease you should be aware of the symptoms.

Coeliac disease is a lifelong autoimmune condition and the gluten free diet is the only treatment for it. If gluten is introduced back into the diet at a later date, the immune system will react and the gut lining will become damaged again.

Once you develop coeliac disease, you must avoid gluten for the rest of your life.

Editions of Crossed Grain magazine will be sent to departments that have registered for the Resource Pack.

Following the information in your autumn edition of professional eXG, you will be aware that we have made significant changes to the 2017 Food and Drink Information services. As a Healthcare Professional working with patients with coeliac disease you too can access the online Information by becoming an individual Member or purchasing a copy of the printed edition of Food and Drink Guide by contacting our Helpline team on 0333 332 2033.

For further information please see our downloadable leaflet.