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Diagnosis guidelines

Guidelines for adults

NICE released a guideline (NG20) on the recognition, assessment and management of coeliac disease in September 2015, replacing the 2009 guideline (CG86) on recognition of coeliac disease. The guideline indicates who to test for coeliac disease, based on recognising the symptoms and associated conditions to target those patients most at risk of coeliac disease. The guideline also covers the diagnosis process and management of coeliac disease.

Key areas for improvement in diagnosis of coeliac disease are highlighted in the NICE quality standard for coeliac disease.

Guidelines for children

The 2015 NICE guideline covers the recognition, assessment and management of coeliac disease in children, young people and adults. 

A guideline for diagnosis and management of children with coeliac disease was published by the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) and Coeliac UK in February 2013. The short and long guideline is based on recommendations from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). 

Further information on diagnosis in children is available on the Coeliac UK website.

The new short and long guidelines are based on the recent recommendations from the European Society for Paediatric Gastroentereology, Hepatology and Nutrition (ESPGHAN). 

In recent years diagnosis was based on a blood test for antibodies followed by a biopsy. However, the accuracy of blood tests has improved and the need for biopsy may lead to delayed diagnosis and treatment.

The new guidelines recommend that children with symptoms and whose blood tests show a high level of IgA tissue transglutaminase antibodies (x10 x upper limit of normal for assay) and who are HLA-DQ2/ DQ8 positive do not need to undergo biopsy to secure diagnosis.

The new recommended approach will aid more accurate diagnosis, help children get treated more quickly and should bring savings to the NHS.

Guidelines in Scotland

Scotland has an equivalent to NICE called the Scottish Intercollegiate Guidelines Network (SIGN). SIGN does not endorse the work of any other guideline development agencies, including NICE. In areas where there is no SIGN guideline, NHS Scotland staff can follow any other guidelines they think meet appropriate standards.

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