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Upcoming changes to the diagnostic approach of coeliac disease in the UK

There have been reports of upcoming changes to the recommendations about how coeliac disease will be diagnosed in the United Kingdom. 

This change is based on a new study that will soon be published. The findings suggest that the transglutaminase antibody test can be used to diagnose coeliac disease in adults without the need for gastroscopy and small bowel biopsy. Similar guidelines have previously been established for children in Europe.

The transglutaminase antibody blood test is not a new discovery and has been available for many years to test for coeliac disease. When the level of the transglutaminase antibody is very high, coeliac disease is much more likely to be present than when the values are only moderately increased.

The “non-biopsy” guidelines apply only in very specific circumstances when the transglutaminase antibody test is very highly elevated (increased over a certain amount). This occurs in less than half of all adults who have a positive antibody value. In most cases the antibody level is increased but not over the cut-off, and when this occurs the current approach of recommending a gastroscopy and small bowel biopsies to diagnose coeliac disease will remain in place.

Not all countries have adopted this new approach to diagnosis. Coeliac Australia’s Medical Advisory Committee will closely review the study and evidence before making a recommendation. Current advice remains that gastroscopy and small bowel biopsies remain the gold-standard for the diagnosis of coeliac disease. The appropriate approach to the diagnosis of coeliac disease during the COVID-19 pandemic should be made in discussion with your medical specialist.

Coeliac Australia will provide an update when more information is available.

14 August 2023