Coeliac disease: making the diagnosis.

### Key points Coeliac disease (CD) is a systemic, immune-mediated disorder precipitated by gluten and related prolamins. It is characterised by gut enteropathy. It can manifest at any age after weaning (6 months onwards). The estimated lifetime prevalence is around 1% when populations are screened, although significantly fewer are diagnosed. This partly reflects the wide range of presenting symptoms—gastrointestinal, non-gastrointestinal and occult—and many of the cases picked up on screening are asymptomatic at presentation. Other factors include gluten restriction before diagnosis, diagnostic overshadowing whereby the condition is not considered when other conditions are present and the fact that cases can test negative and then develop the condition later. This last issue makes the implementation of population screening complex …