Associated Clinical Guidelines
Coeliac disease is associated with a number of other clinical conditions. Individuals with these conditions may have an increased risk of developing coeliac disease. Management guidelines for some of the associated conditions recommend screening for coeliac disease in these patient groups.
The CDRC has complied a summary of the relationship between coeliac disease and the associated condition and summarised the recommendations from the management guidelines. A link to each set of management guidelines has also been included.
Coeliac Disease and Type 1 Diabetes
Both type 1 diabetes and coeliac disease are autoimmune conditions and there is an increased risk of individuals with type 1 diabetes also developing coeliac disease. There are varying estimates of the prevalence of coeliac disease in adult type 1 diabetes, which vary from 0.8-7%1. The estimated overall prevalence range amongst children with type 1 diabetes has been shown to be 0-16%1.
In approximately 90% of patients the diabetes is diagnosed prior to coeliac disease2. The earlier diagnosis of diabetes may be due to the acute onset of symptoms and recognisable presentation of type 1 diabetes. In comparison the variable presentation of coeliac disease is often missed and may be attributed to the diagnosed diabetes. Undetected coeliac disease may present as poor diabetic control, and growth failure in children, or recurrent episodes of hypoglycaemia3,4.
The NICE Clinical Guideline for type 1 diabetes in children, young people and adults recommends children diagnosed with type 1 diabetes should be screened for coeliac disease at diagnosis and then every 3 years until transfer to adult services. It also recommends adults should be screened if they have a low body mass index (BMI) or unexplained weight loss.
Individuals with type 2 diabetes do not have an increased risk of developing coeliac disease when compared to the general population.
Go to NICE Clinical Guideline for type 1 diabetes in children, young people and adults.
References
1. Collin P et al. Endocrinological disorders and celiac disease. Endocrine Reviews 2002;23(4): 464-483
2. Holmes GKT. Screening for coeliac disease in type 1 diabetes. Arch Dis Child 2002;87:495-498
3. Barera G et al. Screening of diabetic children for coeliac disease with antigliadin antibodies and HLA typing. Arch Dis Child 1991;66:491-494
4. Bradbury BL, Scarpello JHB. Recurrent hypoglycaemia as the presenting symptoms of coeliac disease in a patient with type 1 diabetes mellitus. Pract Diab Int 1999;16:89-90
Coeliac Disease and Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder which has an estimated prevalence of 9-12% in the general population5. Symptoms are similar to those of the 'typical' presentation of coeliac disease. Due to the increasingly recognised underdiagnosis of coeliac disease, through serological screening studies, and the similarity of symptoms it is pertinent to consider coeliac disease in this group of patients.
In 2008, NICE published a Clinical Guideline on IBS which recommends that, for individuals who meet the IBS diagnositic criteria, tests should be undertaken to exclude other diagnoses initially, including serological testing for coeliac disease.
Go to NICE Clinical Guideline for irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care
Reference
5.British Society of Gastroenterology. Guideline for the management of irritable bowel syndrome. 2000
Coeliac Disease and Osteoporosis
Malabsorption of calcium in coeliac disease can often lead to a deficiency in calcium and subsequent reduced bone mineral density and osteoporosis. As the diagnosis of coeliac disease can be delayed many individuals with coeliac disease may have experienced calcium malabsorption for a prolonged period of time. In fact, a Coeliac UK survey, amongst a proportion of its members, found that it took 13 years on average for a diagnosis of coeliac disease to be made6. As many as 50% of individuals with coeliac disease may develop osteoporosis7. It is recommended that individuals with coeliac disease have a higher daily calcium requirement to help reduce the risk of developing osteoporosis.
Go to British Society of Gastroenterology Guidelines for osteoporosis in inflammatory bowel disease and coeliac disease.
References
6. Coeliac UK Member Survey, 2006
7.MacFarlane XA et al. Osteoporosis in treated adult coeliac disease. Gut 1995;36:710-714
Coeliac Disease and Anaemia
Coeliac disease, as a cause of malabsorption, has been identified as one of the most important gastrointestinal causes of iron-deficiency anaemia with 4-6% of cases being attributable to coeliac disease8. Similarly, in a separate study, almost 5% of individuals with iron or folate deficiency, screened for coeliac disease, were found to have it9. The inability to digest and absorb nutrients in undetected coeliac disease leads to an increased likelihood of iron and folate deficiency, which in turn can result in anaemia. Approximately 85% of adults with untreated coeliac disease are found to have either asymptomatic iron or folate deficiency10. This has led to the recommendation in clinical guidelines that all individuals with iron-deficiency anaemia should be screened for coeliac disease8.
Go to British Society of Gastroenterology Guidelines for the Management of Iron-Deficiency Anaemia.
References
8. British Society of Gastroenterology. Guidelines for the management of iron-deficiency anaemia. 2005
9.Howard MR et al. A prospective study of the prevalence of undiagnosed coeliac disease in laboratory defined iron and folate deficiency. J Clin Pathology 2002;55:754-757
10.British Society of Gastroenterology. Guidelines for the management of patients with coeliac disease. 2002