Coeliac disease.

BACKGROUND

Coeliac disease (CD) probably affects one in 100 Australians, but is greatly underdiagnosed. Heightened media interest in the negative effects of dietary gluten has led many patients to request testing for CD or follow inappropriate diets. Doctors have had little education in CD because of its perceived rarity.

OBJECTIVE

This article summarises current knowledge of clinical presentations, optimal screening and diagnostic tests, and how the general practitioner can best assist patients in adopting a successful gluten free diet.

DISCUSSION: Coeliac disease is associated with a range of conditions including type 1 diabetes, thyroid disease, osteoporosis, and iron deficiency with or without anaemia. Gastrointestinal symptoms may not be present. The GP therefore has an important role in considering CD in the differential diagnosis in a variety of clinical presentations. Antitransglutaminase IgA and total serum IgA are the preferred screening tests but may miss occasional patients with CD. Endoscopic duodenal biopsy while eating gluten is needed for definitive diagnosis. A gluten free diet is complex, and may fail without the involvement of a skilled dietician.