Context

Guidance

Coeliac disease is an autoimmune condition associated with chronic inflammation of the small intestine, which can lead to malabsorption of nutrients. Dietary proteins known as glutens, which are present in wheat, barley and rye, activate an abnormal mucosal immune response. Clinical and histological improvements usually follow when gluten is excluded from the diet.

Coeliac disease can present with a wide range of clinical features, both gastrointestinal (such as indigestion, diarrhoea, abdominal pain, bloating, distension or constipation) and non‑gastrointestinal (such as fatigue, dermatitis herpetiformis, anaemia, osteoporosis, reproductive problems, neuropathy, ataxia or delayed puberty). Children may also present with features such as faltering growth, static weight or progressive weight loss. Although some people present with typical symptoms, others will initially experience few or no symptoms.

Coeliac disease is a common condition. Population screening studies suggest that in the UK 1 in 100 people are affected. The complications of coeliac disease (which may or may not be present at diagnosis) can include osteoporosis, ulcerative jejunitis, malignancy (intestinal lymphoma), functional hyposplenism, vitamin D deficiency and iron deficiency.

People with conditions such as type 1 diabetes, autoimmune thyroid disease, Down's syndrome and Turner syndrome are at a higher risk than the general population of having coeliac disease. First‑degree relatives of a person with coeliac disease also have an increased likelihood of having coeliac disease.

The treatment of coeliac disease is a lifelong gluten‑free diet. Specific education and information, such as advice and education on alternative foods in the diet to maintain a healthy and varied intake, may increase the likelihood of adherence and a positive prognosis. These could be provided by a dietitian with experience in coeliac disease. However, access to specialist dietetic support is currently patchy in the UK.