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When to test for coeliac disease

The NICE guideline states that serological testing should be offered to children and adults with any of the following signs and symptoms:

  • persistent unexplained abdominal or gastrointestinal symptoms
  • faltering growth
  • prolonged fatigue
  • unexpected weight loss
  • severe or persistent mouth ulcers
  • unexplained iron, vitamin B12 or folate deficiency
  • type 1 diabetes, at diagnosis
  • autoimmune thyroid disease, at diagnosis
  • irritable bowel syndrome (in adults)
  • first degree relatives of people with coeliac disease.

The NICE guideline also recommends to consider serological testing for coeliac disease in people with any of the following:

  • metabolic bone disorder (reduced bone mineral density or osteomalacia)
  • unexplained neurological symptoms (particularly peripheral neuropathy or ataxia)
  • unexplained subfertility or recurrent miscarriage
  • persistently raised liver enzymes with unknown cause
  • dental enamel defects
  • Down's syndrome
  • Turner syndrome.

NICE recommends if people with risk factors for coeliac disease who have been found to be serologically negative develop coeliac disease like symptoms over time, there should be a low threshold for retesting.

They also recommend to refer people with negative serological test results to a gastroenterologist specialist for further assessment if coeliac disease is still suspected.

The NICE quality standard for coeliac disease highlights key areas for improvement in diagnosis of coeliac disease. 

Further information is available on our website on the advice that should be given to patients prior to testing and the recommended tests.


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