Coeliac disease

Question 1

First line investigation?

Answer 1

In adults and young people: Check total IgA is normal (often low in young adults and adults) and if normal then IgA tTG (tissue transglutaminase). If IgA tTG is normal/equivocal/weakly positive then IgA EMA (endomycosial).
If total IgA is deficient then IgG tests - IgG tTG, IgG EMA, IgG DGP (gliadin peptide) - if any one is positive then diagnostic

In children: the same but no testing for IgA EMA

Question 2

What is the amount of gluten that should be eaten before testing?

Answer 2

10g/day for 6 weeks (equals 4 slices of bread/day - two for a child, or 2 meals with gluten)

Question 3

What are two symptoms that require coeliac testing that you were not aware of?

Answer 3

Subfertility/infertility in men and women; unexplained neurological symptoms including peripheral neuropathy/ataxis

Question 4

What would you look at on annual review?

Answer 4

Check negative serology, symptoms; height/weight; adherence to diet / dietitian; consider DEXA and blood tests for FBC, LFTs (TSH if persistent weight gain; BSL if symptomatic), iron/vitamin B12/vitamin D; pneumococcal vaccine 5 yearly