Adults
Coeliac Serology should be offered to people with any of the following:
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Persistent unexplained abdominal or gastrointestinal symptoms -
Faltering growth
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Prolonged fatigue
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Unexpected weight loss
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Severe or persistent mouth ulcers
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Unexplained iron, vitamin B12 or folate deficiency
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Type 1 diabetes, at diagnosis
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Autoimmune thyroid disease, at diagnosis
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Irritable bowel syndrome (in adults)
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First‑degree relatives of people with coeliac disease
A positive family history of coeliac disease is the main risk factor above all others that carries a risk for coeliac disease being present. All immediate relatives of someone with coeliac disease should be screened for coeliac disease using coeliac serology.
Serological testing for coeliac disease should also be considered in people with any of the following:
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Metabolic bone disorder (reduced bone mineral density or osteomalacia)
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Unexplained neurological symptoms (particularly peripheral neuropathy or ataxia)
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Unexplained subfertility or recurrent miscarriage
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Persistently raised liver enzymes with unknown cause
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Dental enamel defects
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Down’s syndrome
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Turner syndrome
Children
Testing should be offered to children and adolescents with unexplained symptoms and signs of:
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Chronic or intermittent diarrhoea
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Failure to thrive, weight loss or stunted growth
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Delayed puberty or amenorrhoea
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Iron-deficiency anaemiae
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Nausea or vomiting, chronic abdominal pain, cramping or distension, chronic constipation
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Chronic fatigue
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Recurrent aphthous stomatitis (mouth ulcers)
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Dermatitis herpetiformis–like rash
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Fracture with inadequate traumas/osteopenia/osteoporosis
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Abnormal liver biochemistry
Asymptomatic children and adolescents with any of the following:
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Type 1 diabetes mellitus (T1DM)
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Down syndrome
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Autoimmune thyroid disease
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Turner syndrome
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Williams syndrome
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Selective immunoglobulin A (IgA) deficiency
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Autoimmune liver disease
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First-degree relatives with CD
Additional tips
Coeliac disease can develop at any age. The median age of diagnosis is 40 years, but do not discount coeliac disease in the young and elderly.
Coeliac disease affects both sexes, with a modest female predominance. Men with coeliac disease are often overlooked.
Coeliac disease is a global disorder that is common in Western populations, North Africa, the Middle East, India and Pakistan. Reports from Asian countries, such as China, are on the rise. Coeliac disease should not be excluded on the basis of a patient’s ethnicity or appearance.
Clinical heterogeneity is substantial. Some patients have minimal or no obvious symptoms, or only extra‑intestinal issues. One-third of patients with coeliac disease are overweight or obese at diagnosis.
