HNY Policy and Pathway Repository - Humber

Coeliac disease isn't an allergy or an intolerance to gluten.

In cases of coeliac disease, the immune system mistakes substances found inside gluten as a threat to the body and attacks them. This damages the surface of the small bowel (intestines), disrupting the body's ability to absorb nutrients from food.

Coeliac disease is a common condition that affects approximately 1 in every 100 people in the UK, though some experts believe this is an underestimate as milder forms are misdiagnosed as Irritable Bowel Syndrome (IBS).  Coeliac disease prevelance is higher in women than men and can occur at any age, but is most common is early childhood or later adulthood (40 years plus).

There is no cure for coeliac disease but the symptoms can be controlled by a Gluten Free Diet (GFD).  If a diagnosis of coeliac disease is confirmed staple foods are available Gluten-Free Prescribing Policy.

Patients diagnosed with Coeliac Disease and who have a  good Gluten Free Diet (GFD) compliance should be referred to Community Dieticians for additional support and annual reviews.

Common symptoms

The most common symptom of coeliac disease is diarrhoea, caused by the body not being able to fully absorb nutrients (malabsorption).

Malabsorption can also lead to stools containing abnormally high levels of steatorrhoea which can make them foul smelling, greasy, frothy and be difficult to flush down the toilet.

• Other common symptoms include:
• bloating or abdominal (stomach) pain
• flatulence and a noisy stomach
• weight loss
• tiredness and fatigue, which may be a sign of iron deficiency anaemia or folate deficiency anaemia and/or malnutrition
• tingling and numbness in hands and feet (peripheral neuropathy)
• vomiting (usually only affects children)
• oedema swelling of hands, feet, arms and legs

Blood should be taken for coeliac serology.  In older children and adults the blood tests can detect the presence of specific IgA antibodies, such as those directed towards tTG and DGP as well as anti-endomysial antibodies (EMA), and can be used to identify individuals with possible coeliac disease. In patients with specific IgA-deficiency (2% of patients with CD) these tests will be falsely negative and  IgG-based tests are then required. In addition, DGP antibodies have been shown to be more reliable than tTG in younger children (especially those less than 2 years of age).  See  Approach to testing for Coeliac Disease.

Children 16+ only, See Referral Guidelines

Referrals to Gastroentronology should be made in line with the Coeliac Disease guidelines via ereferrals.

HERPC prescribing guidlines (For Hull and East Riding prescribing guidelines)

NICE Guidance (NG20) Coeliac Disease: recognition, assessment and management

PSNC - Gluten-free foods restricted on NHS prescriptions