NICE clinical guidelines
Issued: May 2009

Coeliac disease: Recognition and assessment of coeliac disease

This is an extract from the guidance. The complete guidance is available at


Coeliac disease is believed to be present in up to 1 in 100 of the population although only about 10–15% of people with the condition are clinically diagnosed. Many of the remainder may be well, but a significant minority will have chronic problems such as lethargy, gastrointestinal symptoms, or the effects of anaemia. These result in chronic ill health and often extensive medical investigation without a definite diagnosis.

Because coeliac disease can be very effectively treated with a gluten-free diet it is important to identify people with the undiagnosed disease so as to provide satisfactory individual treatment and also to improve the overall health of the community.

To improve the recognition of coeliac disease and to increase the number of people diagnosed with the condition, the Department of Health asked NICE to produce a short clinical guideline about how the disease should be recognised and which people should be assessed for the disease.

The Guideline Development Group (GDG) comprised experts in both adult and paediatric gastroenterology from primary and secondary care, dietitians, patient members and a clinical immunologist. It was supported by the NICE Short Clinical Guidelines Technical Team.

The GDG considered systematically identified and reviewed evidence concerning the recognition of coeliac disease. A new health economic model was also developed to consider the cost effectiveness of serological tests for coeliac disease.

The guideline gives recommendations about the clinical signs, symptoms and types of presentation or conditions that should alert practitioners to consider the presence of coeliac disease, and suggests a scheme of investigation to follow when making the diagnosis. It is expected that implementation of the guideline recommendations will lead to many new cases being diagnosed and much ill health being alleviated.

The GDG hopes that this guideline will be sufficiently clear and non-contentious that its implementation will be routine both in secondary care and in primary care, where most patients with coeliac disease will present.

Professor Peter D Howdle
Chair, Guideline Development Group