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Problems with diagnosis of Coeliac disease
Since other conditions can closely mimic coeliac disease, the correct diagnosis
can only be made by showing that the bowel lining is definitely damaged.
If coeliac disease is suspected, a gluten free diet should not be started, as it
will interfere with establishing the correct diagnosis and may delay the
diagnosis of another condition with similar symptoms. Trialing of a gluten
free diet does not provide a diagnosis of coeliac disease and subsequent
investigations whilst on a gluten free diet will render false negatives.
This includes both the serological testing (blood tests) and the biopsy test.
It is important to discuss the possibility of coeliac disease with a doctor, if
anyone has a close relative with the condition or if they have been treated for
anaemia on previous occasions. Diagnosis of
Coeliac disease Diagnosis relies upon proving that the small bowel
lining shows the typical abnormality (damage) of coeliac disease (villous
attrophy.) This can only be done by carrying out a small bowel biopsy test
(endoscopy), where a special optic fibre instrument is passed through the mouth
with direct viewing of progress by the doctor, who is able to pass a small
biopsy forcep through the instrument when it reaches the small bowel. This
allows tiny pieces of bowel lining to be removed for microscopic examination.
As a biopsy test is essential for proper diagnosis, referral to either an adult
or child specialist gastroenterologist will usually be necessary. A specific
panel of blood tests that measure antibodies to gluten is available as a
screening aid in the diagnosis of coeliac disease. These tests will
provide a simple and rapid means to help a doctor decide which family members
should have biopsies and may also help reduce the incidence of delayed
diagnosis. The possibility of coeliac disease in other members of the family
should be considered. Suspicious symptoms or signs in any close family
member warrant a blood screening test. For both children and adults, the
diagnosis of coeliac disease should be confirmed by repeating the small bowel
biopsy 6 to 12 months after starting the gluten free diet. This is
particularly important in young children because other causes of bowl lining
damage similar to coeliac disease are possible.
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Coeliac Disease - what is it?
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