Coeliac Disease

Question 1

What are the 2 1st line Ix for coeliac disease?

Answer 1

Total IgA (to rule out IgA deficiency)
Serum IgA tTGA [above 2 are 1st line Ix]

Serum IgA endomysial antibody (2nd line)
- if IgA tTGA testing is unavailable, or weakly +ve

Consider checking serum IgG EMA, IgG deamidated gliadin peptide (DGP), or IgG tTGA if there is evidence of IgA deficiency (3rd line)

Ensure that the person has eaten gluten-containing foods in more than one meal a day, for a minimum of 6 weeks, before testing is performed.

Question 2

What is the referral criteria for coeliac disease?

Answer 2

Arrange referral to a gastroenterologist, for specialist endoscopic intestinal biopsy to confirm or exclude the diagnosis, if serology results suggest a diagnosis of coeliac disease

Question 3

What do you do if IgA tTG or IgA EMA is equivocal in adults and children?

Answer 3

Adults: perform the other test

In children: refer to paediatric gastroenterologist

Question 4

What do you do if IgA tTG or IgA EMA is negative?

Answer 4

Assess IgA levels if not already done so.

If low, look at IgG levels i.e IgG tTG or IgG gliadin –> if okay then coeliac disease unlikely

Question 5

What do you do if IgA tTG or IgA EMA is positive?

Answer 5

Refer to paediatric gastroenterologist or gastroenterologist depending on age

Question 6

What advice should you give to patients with coeliac disease?

Answer 6

Avoid gluten in diet

Question 7

What blood tests to do for annual review for coeliac disease patients?

Answer 7

Coeliac serology - assess adherence to gluten-free diet
FBC + Ferritin - screen for IDA
TFT - screen for associated autoimmune thyroid disease
Liver function tests — to screen for associated autoimmune liver disease.
Calcium, vitamin D, vitamin B12, and folate — to assess for deficiency due to malabsorption and dietary changes.