Our newly updated guideline on the diagnosis and management of adult coeliac disease is now available, providing a comprehensive road map for evidence-based, expert investigation and management of this common condition.

This guideline updates the BSG 2014 guideline and comprises 15 recommendations which are evidence-based statements subjected to GRADE methodology, 19 good-practice statements which were informed by indirect or limited evidence, and 6 expert opinions which did not meet the criteria for either of the above but were considered important to the guideline audience.

Key features of the guideline include a pragmatic approach to diagnosing coeliac disease without duodenal biopsies in selected cases, a tailored strategy for patient follow-up, and a comprehensive framework for the investigation and management of non-responsive and refractory coeliac disease.

Dr Hugo Penny, Consultant Gastroenterologist, Sheffield Teaching Hospitals NHS Foundation Trust, who chaired the Guideline Development Group (GDG), says:

“This updated guideline brings together current evidence and expert consensus to support best practice in the diagnosis and management of adult coeliac disease. Developed through a comprehensive process involving multidisciplinary expertise and detailed evidence review, it reflects the latest advances in the field since the previous guideline was published.” 

Dr Heidi Urwin, Director of Evidence and Policy at Coeliac UK who was involved in the development of the guidelines, says: 

“It’s great to see the revised guidelines opening up new routes to diagnosis, for the spectrum of presentations in adult coeliac disease and encouraging discussions between patient and clinician in decision-making.”

“The guidelines outline the need to identify those patients who may be at risk and require additional ongoing support and facilitating easy access for those that are doing well, should things change and they again need help. Ultimately the right care, at the right time for adults with coeliac disease.” 

Joy Whelan, Specialist Dietitian, Western Health and Social Care Trust Londonderry, says: 

“These updated guidelines on the diagnosis and management of coeliac disease, will undoubtedly improve patient care with clear and concise recommendations set out. The implementation of the no-biopsy approach, providing an alternative diagnostic pathway in secondary care for a sub-set of patients, is a fantastic step forward to enable a faster diagnosis leading to improved health more quickly.”

Dr Jeremy Woodward, Consultant Gastroenterologist, Cambridge University Hospitals NHS Foundation Trust and GDG member, says:

“These guidelines, compiled by a panel of UK and International experts, will substantially improve the patient journey with coeliac disease by focusing appropriately on the early period, when most needed to support the changes required in adapting to a gluten-free diet.  They provide welcome clarification on both the diagnosis and the follow-up of the condition, and will result in significant rationalisation of existing pathways and resource utilisation.”

Professor David Sanders, Consultant Gastroenterologist, Royal Hallamshire Hospital Sheffield, Chair of Coeliac UK’s Health Advisory Council and senior author of the guidelines, says: 

“This is a landmark international collaborative publication driven by Dr Penny. It heralds a new era for how we diagnose and manage coeliac disease in adults. These contemporary guidelines are of value to both patients and clinicians. Specifically, when considering the pressure of our UK NHS system, these guidelines offer an alternative evidence-based approach to coeliac disease. This should streamline the patient journey but also provide efficiencies for the NHS.”  

The guideline is available to read HERE.

Our guideline was developed using GRADE methodology to provide the most up-to-date recommendations and best practice statements. The process was overseen by the BSG Clinical Services committee (CS). 

Our guidelines grow out of the collaborative efforts of many members and non-members, specialists and generalists and people with lived experience of the topic being covered. 

All BSG guidelines are published in BMJ GUT under an open access licence and available for free via the BSG website. 

If you’d like to find out more about our guidelines, please email the CS Support Officer, Lisa Moore, [email protected].