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Coeliac disease overview

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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

1 September 2015 Major update on publication of the NICE guideline on coeliac disease: recognition, assessment and management (NG20).

Professional responsibilities

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. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. 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.

Patient-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

Coeliac disease: recognition, assessment and management

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

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.

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

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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

Professional responsibilities

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. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. 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.

Patient-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: February 2016

© NICE 2016

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