New Nhs Nice Coeliac Guidelines To Uk Drs

[georgie]

Recognition and assessment of coeliac disease

NHS NICE Coeliac Guidelines to UK Drs

Clinical guidelines CG86

Issued: May 2009

How reliable are serological tests compared with intestinal biopsy in detecting early coeliac disease?

− Evidence of the presence of coeliac disease can be suggested by the finding of highly specific and sensitive antibodies to tissue transglutaminase and to endomysium. Confirmation of the presence of intestinal damage revealed by the histological examination of small-intestinal biopsies remains the traditional method of making the diagnosis. The sensitivity of this investigation has rarely, if ever, been formally investigated. With increased use of serological tests for coeliac disease it has become evident that some people with positive coeliac autoantibodies have apparently normal small-intestinal histology. Some such people are, nonetheless, symptomatic and have gluten-sensitive malabsorption. Early detection of coeliac disease may be important to prevent long-term complications, Therefore longitudinal studies are needed to determine whether serological markers are superior and can reliably detect early coeliac disease before intestinal damage occurs.

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This is a quick flow chart from the Quick Reference Guide

Does the person have any symptoms in Box A or B

Yes

Is the person on a Gluten containing diet

No

Is the person willing/able to reintroduce Gluten to their diet ?

No

Refer them to a Gastro Specialist and inform them that it may be difficult to confirm a diagnosis on intestinal biopsy , and that this may have implications on their ability to access prescribed gluten-free foods

Box A

Offer serological testing to children and adults with any of the following signs , symptoms and conditions.

Chronic or intermittant diarrhoea

Failure to thrive or faltering growth ( in children)

Prolonged Fatigue ( "tired all the time" )

Recurrent abdominal pain , cramping or distention

Unexplained iron anaemia or other unspecified anaemia

Conditions

Autoimmune Thyroid Disease

Dermititis Herpetiformis

Irritable Bowel Syndrome

Type 1 Diabetes

First degree relatives ( parents, siblings or children ) with Coeliac Disease

Box B

Consider offering serological testing to children and adults with any of the following

Addisons Disease

amenorrhoea

apthous stomatitis ( mouth ulcers)

autoimmune liver conditions

autoimmune myocarditis

chronic Thombocytopenia

dental enamel defects

depression or bipolar disorder

downs syndrome

epilepsy

low trauma fracture

lymphoma

metabolic bone disease

microscopic colitis

persistant or unexplained constipation

persistantly raised liver enzymes with unknown cause

polyneuropathy

recurrent miscarriage

reduced bone mineral density

sarcoidosis

Sjogren's syndrome

Turner syndrome

unexplained alopecia

unexplained subfertility