HNY Policy and Pathway Repository - Humber

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Box 1 - Recognition of Coeliac Disease

Offer serological testing for coeliac disease to:

· People with any of the following:

* Persistent unexplained abdominal of 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)

· Consider serological testing for coeliac disease in people with any of the following:

* Metabolic bone disorder (reduced bone mineral density or osteocalcin)

* 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

 

Box 2— Serological Testing for Coeliac Disease

· Test for total immunoglobulin A (IgA) and IgA tissue transglutaminase (tTG) as the first choice

· Use IgA endomysia antibodies (EMA) if IgA tTG is weakly positive

· Consider using IgG EMA, IgG deamidated gliadin peptide (DGP) or IgG tTG is IgA is deficient.

 

Box 3—GP ongoing management including annual review

· Review symptoms annually (notably diarrhoea, abdominal pain, abdominal bloating , weight loss, fatigue , shortness of breath)

· Offer influenza, meningococcal, and pneumococcal immunisations (due to associated risk of hyposplenism)

· Monitor body weight, height and BMI in children to assess growth and nutritional status

· Prescribe GF products in line with area policy

· Arrange annual blood tests (tTG, FBC, Ferritin, TSH, LFTs, Calcium, Vitamin D, Vitamin B12 and Folate)

· Repeat Dexa (if indicated, in line with NICE guidelines on Osteoporosis)

 

Responsibilities	CDC Basket Name	To include	A&G/CHN Link
GP	Primary care pre referral workup	Immunoglobulin A (IgA) IgA tissue transglutaminase (tTG) IgA endomysia antibodies (EMA) IgA gliadin peptide (DGP)
GP	Primary care annual review, bloods and Dexa	Blood tests – tTG, FEC, Ferritin, TSH, LFTs, Calcium, Vitamin D, Vitamin B12 & Folate Repeat dexa (only available at NEL CDC/ NEL Medical Physics)

 

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