Screening
Routine screening for coeliac disease is not recommended unless you have symptoms associated with the condition or pre-existing risk factors.
In 2009, the National Institute for Health and Clinical Excellence (NICE) issued guidance about when testing for coeliac disease should be carried out. NICE stated that testing for coeliac disease is strongly recommended for adults or children with the following signs or symptoms:
- long-term (chronic) diarrhoea or repeated and regular episodes of diarrhoea
- persistent or unexplained gastrointestinal symptoms (those affecting the digestive system, such as nausea and vomiting)
- prolonged fatigue (feeling tired all the time)
- recurring symptoms of abdominal pain
- cramping or bloating
- sudden or unexplained weight loss
- unexplained anaemia
- weight loss
- failure to thrive in infants/toddlers
Testing is also recommended if you have the following conditions:
In some circumstances, testing may also be recommended if you have any of the following conditions:
- Addison’s disease, a condition where the immune system attacks certain glands in the body
- Down’s syndrome, a genetic condition that causes abnormal physical and mental development
- epilepsy
- lymphoma, a type of cancer
- bone diseases, such as rickets (a condition that causes softening and weakening of the bones)
- persistent or unexplained constipation
- repeated miscarriages
- Sjogren’s syndrome, a condition where the immune system attacks the tears and saliva glands
- Turner syndrome, a genetic condition that only affects women and causes infertility and delayed growth
- unexplained infertility
- unexplained weight loss
Screening for coeliac disease involves a two stage process:
- blood tests to help identify people who may have coeliac disease
- gut biopsy to confirm the diagnosis
These procedures are described in more detail below.
Blood test
Your GP will take a blood sample and test it for certain antibodies that are usually present in the bloodstream of people with coeliac disease. You should not be avoiding gluten from your diet when the blood test is done as this could lead to an inaccurate result.
However, it is sometimes possible to have coeliac disease and not have these antibodies in your blood. If coeliac disease antibodies are found in your blood, your GP will refer you for a biopsy of your gut.
Gut biopsy
A gut biopsy is carried out in hospital, usually by a gastroenterologist (a specialist in treating conditions of the stomach and intestines). A gut biopsy can help confirm a diagnosis of coeliac disease.
If you need to have a gut biopsy, an endoscope (a thin, flexible tube with a light and a tiny cutting tool on the end) will be inserted into your mouth and gently passed down to your small intestine. Before the procedure, you will be given a local anaesthetic and a sedative to numb your throat and help you relax.
The gastroenterologist will use the cutting tool at the end of the endoscope to cut away a small piece of tissue from your small intestine. The sample will then be examined in a laboratory for signs of coeliac disease.
Tests after diagnosis
If you are diagnosed with coeliac disease, you may also have a number of other tests to assess how the condition has affected you so far.
You may have further blood tests to check the levels of iron and other vitamins and minerals in your bloodstream. This will help determine whether coeliac disease has led to you developing anaemia (a lack of iron in your blood) due to poor digestion.
If you appear to have dermatitis herpetiformis (an itchy rash that is also caused by gluten intolerance), you may have a skin biopsy to confirm it.
This will be carried out in a similar way to a gut biopsy.
A small skin sample will be taken from an area that is unaffected by the rash so that it can later be examined.
In some cases of coeliac disease, a DEXA scan may also be recommended. A DEXA scan is a type of X-ray that measures bone density. It may be necessary if your GP thinks that your condition may have started to damage your bones. In coeliac disease, a lack of nutrients, caused by poor digestion, can make your bones weak and brittle (osteoporosis).
