Is coeliac disease
hiding in plain sight?

Look for the truth with the help of coeliac serology.

Brought to you by Brought to you by Thermo Fisher

Coeliac disease is an
under-diagnosed, under-managed condition

Coeliac disease is no longer thought of as a classical presentation of malnutrition at childhood. It can present as one of several vague symptoms or disease comorbidities at any age.1

IBS2,3Up to 4.7% of IBS patients have coeliac disease

Stomatitis4>20% of patients with coeliac disease suffer from mouth ulcers

Unexplained anaemia5Iron deficiency anaemia occurs in up to 50% of coeliac disease patients at diagnosis

Sub-fertility6,7Up to 8% of couples with sub-fertility have coeliac disease

Type 1 diabetes8Up to 16% of patients with type 1 diabetes have coeliac disease

First-degree relatives9Approx. 7.5% of first-degree relatives of patients with coeliac disease will have coeliac disease

>70%of patients with coeliac disease have yet to be diagnosed10

IBS2,3Up to 4.7% of IBS patients have coeliac disease

Stomatitis4>20% of patients with coeliac disease suffer from mouth ulcers

Unexplained anaemia5Iron deficiency anaemia occurs in up to 50% of coeliac disease patients at diagnosis

Sub-fertility6,7Up to 8% of couples with sub-fertility have coeliac disease

Type 1 diabetes8Up to 16% of patients with type 1 diabetes have coeliac disease

First-degree relatives9Approx. 7.5% of first-degree relatives of patients with coeliac disease will have coeliac disease

>70%

of patients with coeliac disease have yet to be diagnosed10

IBS2,3Up to 4.7% of IBS patients have coeliac disease

Stomatitis4>20% of patients with coeliac disease suffer from mouth ulcers

Unexplained anaemia5Iron deficiency anaemia occurs in up to 50% of coeliac disease patients at diagnosis

Sub-fertility6,7Up to 8% of couples with sub-fertility have coeliac disease

Type 1 diabetes8Up to 16% of patients with type 1 diabetes have coeliac disease

First-degree relatives9Approx. 7.5% of first-degree relatives of patients with coeliac disease will have coeliac disease

>70%of patients with coeliac disease have yet to be diagnosed10

The presence of coeliac disease in these patients is often 'hidden' so it is important to look for the truth by case-finding with the aid of coeliac serology11-21

Case-finding for coeliac disease in these high-risk populations is recommended11-21

THINK COELIAC

Why should you case-find for coeliac disease in high-risk populations?

TEST COELIAC

Which coeliac serology should you request to aid your differential diagnosis?

TREAT COELIAC

What are the benefits of early diagnosis and management in coeliac disease?

THINK COELIACWhy should you case-find for coeliac disease in high-risk populations?

TEST COELIACWhich coeliac serology should you request to aid your differential diagnosis?

TREAT COELIACWhat are the benefits of early diagnosis and management in coeliac disease?

THINK COELIAC: Why case-find?

Who?

It is recommended that you consider serological testing for coeliac disease in people with:11-21

  • First or second-degree relatives who have coeliac disease
  • IBS
  • Type 1 diabetes
  • Sub-fertility and poor pregnancy outcomes
  • Persistent unexplained abdominal or gastrointestinal symptoms
  • Faltering growth
  • Prolonged fatigue
  • Unexpected weight loss
  • Unexplained iron, vitamin B12 or folate deficiency
  • Autoimmune thyroid disease, at diagnosis
  • Metabolic bone disorder (reduced bone mineral density or osteomalacia)
  • Unexplained neurological symptoms (particularly peripheral neuropathy or ataxia)
  • Persistent raised liver enzymes with unknown cause
  • Dental enamel defects
  • Down's syndrome
  • Turner syndrome
How many patients in your practice could have
underlying coeliac
disease?

Why test?

13years
The average time from symptom onset to correct diagnosis of coeliac disease is 13 years22
Untreated patients are more likely to develop long-lasting complications23
Coeliac disease is manageable, and symptoms can be resolved, by strictly adhering to a lifelong gluten-free diet11,24-29

What are the potential complications of untreated coeliac disease?22

  • Central and peripheral system disorders
  • Iron deficiency anaemia
  • Secondary lactose intolerance
  • Gall bladder malfunction
  • Vitamin and mineral deficiencies
  • Early onset osteoporosis or osteopenia
  • Pancreatic insufficiency
  • Sub-fertility
TREAT COELIAC: What are the benefits of early
diagnosis and management in coeliac disease?
Thank you for voting
Please select an option

Will you test the next patient you see who has a high risk for coeliac disease?

  • A - 67%
  • B - 5%
  • C - 27%
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References
  1. Muray JA, et al. Clin Gastroenterol Hepatol 2003 1(1): 13-27.
  2. Cristofori F, et al. JAMA Pediatrics 2014:168;555-560.
  3. El-Sahly M, et al. Nutr J 2015;14:92.
  4. Campisi G, et al. Dig Liver Dis 2008;40(2):104-107.
  5. Ludvigsson J F et al. J Am Med Inform Assoc 2013: e2; e306-e310
  6. Lasa JS, et al. Arq Gastroenterol 2014;51:144-50.
  7. Karaca N, et al. Turk J Gastroenterol 2015;26:484-6.
  8. Holmes GKT. Arch Dis Child 2002; 87: 495-499.
  9. Singh P, et al. Am J Gastroenterol 2015;110:1539-1548.
  10. West J, et al. Am J Gastroenterol 2014;109:757-768.
  11. National Institute for Health and Care Excellence. Coeliac Disease –Recognition, assessment and management (NG20). 2015. London: National Institute for Health and Care Excellence.
  12. National Institute for Health and Care Excellence. Irritable bowel syndrome in adults: diagnosis and management (CG61). 2015. London: National Institute for Health and Care Excellence.
  13. Ludvigsson JF, et al. Gut 2014;63(8):1210-1228.
  14. World Gastroenterology Organisation. IBS: A global perspective. Available from http://www.worldgastroenterology.org/guidelines/global-guidelines/irritable-bowel-syndrome-ibs/irritable-bowel-syndrome-ibs-english; last accessed May 2016.
  15. American Diabetes Association. Diabetes Care 2015;38 (Suppl. 1): S1–S2.
  16. American Diabetes Association. Diabetes Care 2015;38 (Suppl. 1):S17–S19.
  17. International Diabetes Federation. Global IDF/ISPAD Guideline for Diabetes in Childhood and adolescence. 2011. Available from http://www.idf.org/sites/default/files/Diabetes-in-Childhood-and-Adolescence-Guidelines.pdf; last accessed May 2016.
  18. Scottish Intercollegiate Guidelines Network. Management of Diabetes (116). 2014.
  19. Husby S, et al. JPGN 2012;54:136-160.
  20. Rubio-Tapia A, et al. Am J Gastroenterol 2013;108@656-676.
  21. World Gastroenterology Organisation. Coeliac disease: Global guidelines. Available from http://www.worldgastroenterology.org/guidelines/global-guidelines/celiac-disease/celiac-disease-english; last accessed July 2018.
  22. Gray AM and Papanicolas N. BMC Health Services Research 2010; 10:105.
  23. Celiac Disease Foundation: Celiac Disease Symptoms. Available from https://celiac.org/celiac-disease/understanding-celiac-disease-2/what-is-celiac-disease/24477-2; Last accessed July 2018.
  24. Elfström P, et al. Aliment Pharmacol Ther 2014;40(10):1123-32.
  25. Grace-Farfaglia, P. Nutrients 2015;7:3347-3369.
  26. Murch S, et al. Arch Dis Child 2013;98:806-811.
  27. Shar S and Leffler D. Womens Health (Lond Engl) 2010;6(5):753-766.
  28. Smedby K, et al. Gut 2005;54:54-59.
  29. Violato M, et al. PLoS One 2012;7(7):e41308.
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