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Coeliac disease

About

What is covered

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 be present at diagnosis) can include osteoporosis, ulcerative jejunitis, malignancy (intestinal lymphoma), functional hyposplenism, vitamin D deficiency and iron deficiency.
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.
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; access to specialist dietetic support is currently patchy within the UK.

Updates

Updates to this pathway

18 October 2016 Coeliac disease (NICE quality standard 134) added.
1 September 2015 Major update on publication of the NICE guideline on coeliac disease: recognition, assessment and management (NG20).

Your responsibility

Guidelines

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this pathway is not mandatory and does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the pathway to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Technology appraisals

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this pathway is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the pathway does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Short Text

Everything NICE has said on recognising, diagnosing and managing coeliac disease in an interactive flowchart

What is covered

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 be present at diagnosis) can include osteoporosis, ulcerative jejunitis, malignancy (intestinal lymphoma), functional hyposplenism, vitamin D deficiency and iron deficiency.
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.
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; access to specialist dietetic support is currently patchy within the UK.

Updates

Updates to this pathway

18 October 2016 Coeliac disease (NICE quality standard 134) added.
1 September 2015 Major update on publication of the NICE guideline on coeliac disease: recognition, assessment and management (NG20).

Sources

NICE guidance and other sources used to create this pathway.
Coeliac disease (2016) NICE quality standard 134

Quality standards

Coeliac disease

These quality statements are taken from the coeliac disease quality standard. The quality standard defines clinical best practice in coeliac disease and should be read in full.

Quality statements

Serological testing for coeliac disease

This quality statement is taken from the coeliac disease quality standard. The quality standard defines clinical best practice in coeliac disease and should be read in full.

Quality statement

People at increased risk or with symptoms of coeliac disease are offered a serological test for coeliac disease.

Rationale

Coeliac disease is currently underdiagnosed. If coeliac disease is not recognised, there is a risk of complications, unnecessary investigations and a poor quality of life. Offering serological testing when there is a new diagnosis for a condition that increases the risk of having coeliac disease or at presentation of symptoms of coeliac disease will improve detection and diagnosis, thereby enabling people to begin treatment.

Quality measures

Structure
Evidence of local arrangements to undertake serological testing for people identified with increased risk or symptoms of coeliac disease.
Data source: Local data collection.
Process
a) Proportion of people at increased risk of coeliac disease who receive a serological test for coeliac disease.
Numerator – the number in the denominator who receive a serological test for coeliac disease.
Denominator – the number of people at increased risk of coeliac disease (people with type 1 diabetes or autoimmune thyroid disease at diagnosis, and first- degree relatives of people newly diagnosed with coeliac disease).
Data source: Local data collection. The Royal College of Paediatrics and Child Health National Paediatric Diabetes Audit collects data on coeliac disease screening in children and young people with type 1 diabetes.
b) Proportion of people with symptoms of coeliac disease who receive a serological test for coeliac disease.
Numerator – the number in the denominator who receive a serological test for coeliac disease.
Denominator – the number of people who have symptoms of coeliac disease.
Data source: Local data collection. To aid practicality of measurement, service providers and commissioners could focus on people presenting with symptoms of irritable bowel syndrome.
Outcome
Diagnosed prevalence of coeliac disease.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (for example general practices, community healthcare providers and secondary care) ensure that they take a case-finding approach to identifying coeliac disease by offering a serological test to people at increased risk or with symptoms of coeliac disease. Providers should ensure that tests for coeliac disease are only carried out when a gluten-containing diet has been followed for at least 6 weeks.
Healthcare professionals (such as GPs and consultants) offer a serological test for coeliac disease to people at increased risk or with symptoms of coeliac disease, and ensure that people have been following a gluten-containing diet for at least 6 weeks before the test.
Commissioners (such as clinical commissioning groups and NHS England) commission services that take a case-finding approach to identifying coeliac disease by offering a serological test to people at increased risk or with symptoms of coeliac disease; and ensure that they commission a pathology service that has access to the serological tests for coeliac disease.

What the quality statement means for patients and carers

People who may have, or who are at risk of developing, coeliac disease are offered a blood test to check for the disease. It is important to diagnose coeliac disease because it can cause long-term health problems if it is not treated. Before having the test, people need to follow a diet that includes foods that contain gluten for at least 6 weeks.

Source guidance

Definitions of terms used in this quality statement

People at increased risk or with symptoms of coeliac disease
A serological test for coeliac disease should be offered to:
  • people with any of the following:
    • persistent unexplained abdominal or 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
  • adults who meet the irritable bowel syndrome diagnostic criteria
  • first-degree relatives of people newly diagnosed with coeliac disease.
[Coeliac disease (NICE guideline NG20) recommendation 1.1.1 and Irritable bowel syndrome in adults (NICE guideline CG61) recommendation 1.1.2.1]
Serological test for coeliac disease
When healthcare professionals request serological tests to investigate suspected coeliac disease in children, young people and adults, laboratories should test for total immunoglobulin A (IgA) and IgA tissue transglutaminase (tTG) as the first choice. In young people and adults, laboratories should use lgA endomysial antibodies (EMA) if lgA tTG is weakly positive and should consider using lgG EMA, lgG DGP or lgG tTG if lgA is deficient. A serological test for coeliac disease is only accurate if a gluten-containing diet has been followed for at least 6 weeks.
[Adapted from Coeliac disease (NICE guideline NG20) recommendations 1.1.3, 1.2.2 and 1.2.3]

Referral to a specialist

This quality statement is taken from the coeliac disease quality standard. The quality standard defines clinical best practice in coeliac disease and should be read in full.

Quality statement

People with a positive serological test for coeliac disease are referred to a specialist and advised to continue with a gluten-containing diet until diagnosis is confirmed.

Rationale

As a positive serological result for coeliac disease is not sufficient to confirm diagnosis, people should be referred to a specialist for assessment and further investigation. Confirming diagnosis will ensure that people with coeliac disease can get support to help them manage their condition.

Quality measures

Structure
a) Evidence of local arrangements to ensure that people with a positive serological test for coeliac disease are referred to a specialist.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that people referred to a specialist following a positive serological test for coeliac disease are advised to continue with a gluten containing diet until diagnosis is confirmed.
Data source: Local data collection.
Process
a) Proportion of people with a positive serological test for coeliac disease who are referred to a specialist.
Numerator – the number in the denominator who are referred to a specialist.
Denominator – the number of people with a positive serological test for coeliac disease.
Data source: Local data collection.
b) Proportion of people referred to a specialist following a positive serological test for coeliac disease who are advised to continue with a gluten-containing diet until diagnosis is confirmed.
Numerator – the number in the denominator who are advised to continue with a gluten-containing diet until diagnosis is confirmed.
Denominator – the number of people referred to a specialist following a positive serological test for coeliac disease.
Data source: Local data collection.
Outcome
Diagnosed prevalence of coeliac disease.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (for example general practices, community healthcare providers and secondary care) ensure that processes are in place for people with a positive serological test for coeliac disease to be referred to a specialist and advised to continue with a gluten-containing diet until diagnosis is confirmed.
Healthcare professionals (such as GPs and consultants) refer people with a positive serological test for coeliac disease to a specialist and advise them to continue with a gluten-containing diet until diagnosis is confirmed.
Commissioners (such as clinical commissioning groups and NHS England) commission services that refer people with a positive serological test for coeliac disease to a specialist and advise them to continue with a gluten-containing diet until diagnosis is confirmed. Commissioners also ensure that an effective specialist service for people with coeliac disease has capacity to meet expected demand.

What the quality statement means for patients and carers

People who have had a blood test that shows they might have coeliac disease should be referred to a specialist to have more tests to confirm whether or not they have coeliac disease. They should carry on eating foods containing gluten until they find out whether or not they have coeliac disease.

Source guidance

Definitions of terms used in this quality statement

Positive serological test for coeliac disease
When healthcare professionals request serological tests to investigate suspected coeliac disease, laboratories should test for total immunoglobulin A (IgA) and IgA tissue transglutaminase (tTG) as the first choice. A positive serological test result is defined as unambiguously positive IgA tTG alone, or weakly positive IgA tTG and positive IgA endomysial antibodies (EMA). In people who have IgA deficiency, a serologically positive result can be derived from any one of the IgG antibodies.
[Coeliac disease (NICE guideline NG20) recommendations 1.2.2, 1.2.3 and 1.3.1]
Referral to a specialist
People aged 16 and over should be referred to a gastrointestinal specialist for endoscopic intestinal biopsy. Children and young people under 16 should be referred to a paediatric gastroenterologist or paediatrician with a specialist interest in gastroenterology for further investigation that may include, but is not limited to, one or more of the following:
  • an endoscopic biopsy
  • an IgA EMA test to confirm serological positivity
  • human leukocyte antigen (HLA) genetic testing.
[Coeliac disease (NICE guideline NG20) recommendations 1.3.1 and 1.3.2]
Gluten-containing diet
People who are following a normal diet (containing gluten) should be advised to eat gluten in more than 1 meal every day for at least 6 weeks before testing for coeliac disease.
[Coeliac disease (NICE guideline NG20) recommendation 1.1.4]

Endoscopic intestinal biopsy

This quality statement is taken from the coeliac disease quality standard. The quality standard defines clinical best practice in coeliac disease and should be read in full.

Quality statement

People referred to a specialist who need an endoscopic intestinal biopsy to diagnose coeliac disease have it within 6 weeks of referral.

Rationale

A long wait for an endoscopic intestinal biopsy can mean that some people will start a gluten-free diet to relieve symptoms and will therefore not be able to complete the diagnosis process. Limiting the time that people need to continue with a gluten-containing diet to 6 weeks or less will encourage more people to complete the diagnosis process and enable them to get the support they need.

Quality measures

Structure
Evidence of local processes to ensure that people referred to a specialist who need an endoscopic intestinal biopsy to diagnose coeliac disease have it within 6 weeks of referral.
Data source: Local data collection.
Process
a) Proportion of people referred to a specialist who need an endoscopic intestinal biopsy to diagnose coeliac disease who have it within 6 weeks of referral.
Numerator – the number in the denominator who have an endoscopic intestinal biopsy within 6 weeks of referral.
Denominator – the number of people referred to a specialist who need an endoscopic intestinal biopsy to diagnose coeliac disease.
Data source: Local data collection.
b) Proportion of people with a positive serological test for coeliac disease who complete the diagnosis process.
Numerator – the number in the denominator who complete the diagnosis process.
Denominator – the number of people with a positive serological test for coeliac disease.
Data source: Local data collection.
Outcome
Diagnosed prevalence of coeliac disease.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals, and commissioners

Service providers (secondary care) ensure that people referred to a specialist who need an endoscopic intestinal biopsy to diagnose coeliac disease have it within 6 weeks of referral.
Healthcare professionals (such as gastroenterologists and paediatricians) carry out an endoscopic intestinal biopsy to diagnose coeliac disease within 6 weeks of referral.
Commissioners (clinical commissioning groups) commission services with sufficient capacity to carry out an endoscopic intestinal biopsy to diagnose coeliac disease within 6 weeks of referral to a specialist.

What the quality statement means for patients and carers

People who have had a blood test that shows they might have coeliac disease may need a biopsy to confirm the diagnosis. The biopsy should be carried out within 6 weeks of the referral. They will need to carry on eating foods containing gluten until they have had the biopsy.

Source guidance

Definitions of terms used in this quality statement

Referral to a specialist
People aged 16 and over should be referred to a gastrointestinal specialist. Children and young people under 16 should be referred to a paediatric gastroenterologist or paediatrician with a specialist interest in gastroenterology.
[Coeliac disease (NICE guideline NG20) recommendations 1.3.1 and 1.3.2]

Advice about a gluten-free diet

This quality statement is taken from the coeliac disease quality standard. The quality standard defines clinical best practice in coeliac disease and should be read in full.

Quality statement

People newly diagnosed with coeliac disease discuss how to follow a gluten-free diet with a healthcare professional with specialist knowledge of coeliac disease.

Rationale

A gluten-free diet is the main treatment for coeliac disease. If people with coeliac disease do not follow a gluten-free diet they may experience continuing ill health and be at risk of serious long-term complications. Personalised information and advice about a gluten-free diet from a healthcare professional with specialist knowledge of coeliac disease will help people to understand and self-manage their condition.

Quality measures

Structure
Evidence of local arrangements to ensure that people newly diagnosed with coeliac disease discuss how to follow a gluten free diet with a healthcare professional with specialist knowledge of coeliac disease.
Data source: Local data collection.
Process
Proportion of people newly diagnosed with coeliac disease who discuss how to follow a gluten-free diet with a healthcare professional with specialist knowledge of coeliac disease.
Numerator – the number in the denominator who discuss how to follow a gluten-free diet with a healthcare professional with specialist knowledge of coeliac disease.
Denominator – the number of people newly diagnosed with coeliac disease.
Data source: Local data collection.
Outcome
a) Satisfaction among people with coeliac disease that they are supported to manage their condition.
Data source: Local data collection.
b) Health-related quality of life for people with coeliac disease.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (for example general practices, community healthcare providers and secondary care) ensure that processes are in place for people newly diagnosed with coeliac disease to discuss how to follow a gluten-free diet with a healthcare professional with specialist knowledge of coeliac disease, such as a dietitian.
Healthcare professionals (such as consultants or GPs) ensure that people newly diagnosed with coeliac disease discuss how to follow a gluten-free diet with a healthcare professional with specialist knowledge of coeliac disease, such as a dietitian.
Commissioners (such as clinical commissioning groups and NHS England) commission services that ensure that people newly diagnosed with coeliac disease discuss how to follow a gluten-free diet with a healthcare professional with specialist knowledge of coeliac disease, such as a dietitian, and that services have sufficient capacity to meet demand.

What the quality statement means for patients and carers

People who have coeliac disease and their carers (if appropriate) discuss how to follow a gluten-free diet with a healthcare professional with specialist knowledge of coeliac disease, such as a dietitian.

Source guidance

Definitions of terms used in this quality statement

Discussion about how to follow a gluten-free diet
Healthcare professionals should tell people about the importance of a gluten-free diet and give them information to help them follow it, including:
  • information on which types of food contain gluten and suitable alternatives, including gluten-free substitutes
  • information on which types of food are naturally gluten-free
  • explanations of food labelling
  • information sources about gluten-free diets, recipe ideas and cookbooks
  • how to manage social situations, eating out and travelling away from home, including travel abroad
  • avoiding cross contamination in the home and minimising the risk of accidental gluten intake when eating out
  • the role of national and local coeliac support groups.
[Coeliac disease (NICE guideline NG20) recommendation 1.6.3 and expert opinion]

Equality and diversity considerations

Gluten‑free products are more expensive and are usually only available from larger retailers, making access more difficult for people on low incomes or with limited mobility. As coeliac disease can affect more than one member of a family it can also be an additional burden on the family budget. To address this, healthcare professionals should highlight if gluten-free food products are available on prescription to help people to maintain a gluten‑free diet.

Annual review

This quality statement is taken from the coeliac disease quality standard. The quality standard defines clinical best practice in coeliac disease and should be read in full.

Quality statement

People with coeliac disease are offered an annual review.

Rationale

An annual review should be offered to people with coeliac disease so that adherence to a gluten-free diet and symptoms can be reviewed, information and advice about the condition and diet can be refreshed, and any further support needs can be identified. Annual reviews for children with coeliac disease also allow any impact on development to be assessed. Annual reviews provide the opportunity to identify people with refractory coeliac disease that does not improve with a gluten-free diet and to monitor any emerging long-term complications of coeliac disease.

Quality measures

Structure
Evidence of local arrangements to ensure that people with coeliac disease are offered an annual review.
Data source: Local data collection.
Process
Proportion of people diagnosed with coeliac disease for more than 12 months who received an annual review in the previous 12 months.
Numerator – the number in the denominator who received an annual review in the previous 12 months.
Denominator – the number of people diagnosed with coeliac disease for more than 12 months.
Data source: Local data collection.
Outcome
a) Health-related quality of life for people with coeliac disease.
Data source: Local data collection.
b) Identification of complications associated with coeliac disease.
Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as general practices, community healthcare providers and secondary care) ensure that people with coeliac disease, including those discharged from secondary care, are offered an annual review and are given information about why they may need a review to encourage attendance. Service providers should consider innovative approaches to undertake reviews, including using technology to improve access to specialist advice.
Healthcare professionals (for example, dietitians, consultants, and GPs) offer an annual review to people with coeliac disease, including those discharged from secondary care, and encourage them to attend by giving them information about why they may need a review.
Commissioners (for example, clinical commissioning groups and NHS England) ensure that they commission services that offer an annual review to people with coeliac disease, including those discharged from secondary care. Commissioners encourage service providers to use innovative approaches to undertake reviews, including using technology to improve access to specialist advice.

What the quality statement means for patients and carers

People who have coeliac disease have a check-up once a year to check their symptoms and diet, and to find out whether they need further advice or assessment.

Source guidance

Definitions of terms used in this quality statement

Annual review
An annual review for people with coeliac disease should include:
  • measuring weight and height
  • review of symptoms
  • considering the need for assessment of diet and adherence to the gluten free diet
  • considering the need for specialist dietetic and nutritional advice
  • considering the need for referral to a GP or consultant to address any concerns about possible complications or comorbidities.
[Coeliac disease (NICE guideline NG20) recommendations 1.4.3 and 1.4.4]

Equality and diversity considerations

People living in socioeconomically deprived areas are less likely to attend an annual review. Healthcare professionals in these areas should therefore agree a local approach to encourage as many people as possible to attend.

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Effective interventions library

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Implementation

NICE has produced resources to help implement its guidance on:

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Your responsibility

Guidelines

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this pathway is not mandatory and does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the pathway to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Technology appraisals

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this pathway is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the pathway does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting information

Glossary

deamidated gliadin peptide
endomysial antibodies
immunoglobulin A
tissue transglutaminase

Paths in this pathway

Pathway created: October 2012 Last updated: October 2016

© NICE 2016

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