GPs urged to consider coeliac diagnosis

Aug 21 2017

Professor Marjorie Walker

A review article led by the University of Newcastle (UON) has revealed a recommended approach for the diagnosis and management of coeliac disease in Australia.

Published today in the Medical Journal of Australia, the paper finds that screening high risk patients (active case finding) for coeliac disease when they show signs of being unwell is most effective among the community.

Professor of Anatomical Pathology Marjorie Walker, said that cases of coeliac disease are being overlooked and remain undiagnosed worldwide.

“It is really important that practitioners have an understanding of how common coeliac disease is. At least one to two people in 100 will have the disease, and of those around 80% are going undiagnosed in the community,” Professor Walker explained.

“We’ve also noticed that symptoms have changed over the years. Patients present with symptoms or signs that are very varied and can range from classic symptoms such as diarrhoea, weight loss and faltering growth in children, to more general problems including mouth ulcers, fatigue and autoimmune diseases,” she said.

Coeliac disease is a condition triggered by exposure to gluten. If left undiagnosed and untreated, the disease may lead to damage to the small bowel mucosa and poor absorption with nutritional deficiencies.

“Our main recommendations from this review are that practitioners think about coeliac disease as a diagnosis when patients may have rather vague abdominal symptoms, have a close relative with coeliac disease, and to follow diagnostic guidelines,” Professor Walker said.

“Diagnosis can be first suggested by a simple blood test, but this must be done while the patient is including gluten in their diet at the time of the test. A biopsy is needed to confirm the diagnosis.

“Once confirmed, the patient needs to be followed up and supported by their medical practitioner to continue managing the disease, particularly to ensure they are following a gluten free diet. A dietician’s advice is invaluable” she added.

Based at the Hunter Medical Research Institute, Professor Walker is Co-Director of UON’s Priority Research Centre for Digestive Health and Neurogastroenterology.