Excerpt

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, short stature, neuropathy, ataxia or delayed puberty). Although some people present with typical symptoms, others have few or no symptoms.

People with autoimmune conditions such as type 1 diabetes and autoimmune thyroid disease, or people with a first-degree family history of coeliac disease, have an increased likelihood of coeliac disease.

Contents

• 1. Overview
  • 1.1. Introduction
  • 1.2. Health and resource burden
  • 1.3. Reasons for the guideline
  • 1.4. Population
  • 1.5. Healthcare setting
  • 1.6. Medicines
  • 1.7. Patient-centred care
• 2. Summary section
  • 2.1. Guideline update
  • 2.2. Guideline development group members
  • 2.3. Strength of recommendations
  • 2.4. Key priorities for implementation
  • 2.5. Full list of recommendations
  • 2.6. Key research recommendations
• 3. Methods
  • 3.1. Developing review questions and protocols and identifying evidence
  • 3.2. Outcomes
  • 3.3. Process
  • 3.4. Health economics
  • 3.5. Agreeing the recommendations
• 4. Evidence for the recognition of coeliac disease
  • 4.1. Signs & symptoms
  • 4.2. Populations at increased risk of coeliac disease
  • 4.3. Conditions associated with undiagnosed/untreated coeliac disease
  • 4.4. Active case-finding
• 5. Evidence for testing for coeliac disease
  • 5.1. Accuracy of serological testing
  • 5.2. Order and sequencing of serological tests
  • 5.3. Criteria for referral for endoscopic intestinal biopsy
  • 5.4. Routine monitoring
• 6. Evidence for non-responsive and refractory coeliac disease
  • 6.1. Causes of non-responsive coeliac disease
  • 6.2. Pharmacological interventions
  • 6.3. Nutritional interventions
  • 6.4. Autologous stem-cell transplants
• 7. Evidence for information and support related to coeliac disease
  • 7.1. At diagnosis
  • 7.2. Evidence to improve adherence to a gluten-free diet
  • 7.3. Evidence for advice on dietary management
• 8. References
• 9. Glossary
• 10. List of abbreviations
• Appendices
  • Appendix A. Guideline development group declarations of interest
  • Appendix B. Scope
  • Appendix C. Review Protocols & Search Strategy
  • Appendix D. Evidence Tables
  • Appendix E. GRADE profiles
  • Appendix F. Excluded studies
  • Appendix G. Full health economics report

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.