This guideline covers the recognition, assessment and management of coeliac disease in children, young people and adults. It updates and replaces NICE guideline CG86.
Coeliac disease is an autoimmune condition associated with chronic inflammation of the small intestine, which can lead to malabsorption of nutrients. Dietary proteins known as glutens, which are present in wheat, barley and rye, activate an abnormal mucosal immune response. Clinical and histological improvements usually follow when gluten is excluded from the diet.
Coeliac disease can present with a wide range of clinical features, both gastrointestinal (such as indigestion, diarrhoea, abdominal pain, bloating, distension or constipation) and
non-gastrointestinal (such as fatigue, dermatitis herpetiformis, anaemia, osteoporosis, reproductive problems, neuropathy, ataxia or delayed puberty). Children may also present with
features such as faltering growth, static weight or progressive weight loss. Although some people present with typical symptoms, others will initially experience few or no symptoms.