The Covid-19 pandemic changed our lives in a wide variety of ways, some of which have had a long-term impact far beyond the pandemic itself. One of those changes has been in coeliac disease diagnosis.

How was coeliac disease previously diagnosed?

Coeliac disease diagnosis was previously a two-stage process. The first stage of diagnosis was a series of blood tests. If these results suggested coeliac disease, then the patient would be scheduled for a gut biopsy at their local  hospital.

These appointments were usually scheduled for around six weeks after the blood test results. During this wait, the patient had to maintain a diet containing gluten, because after gluten is removed the gut begins to heal. Therefore, coeliac disease diagnosis would not be possible. This meant that they had to continue to endure their coeliac disease symptoms while they waited for biopsy. NHS statistics show that by the later stages of the pandemic, in July 2021, almost 40% of patients were waiting longer than six weeks, increasing their suffering from coeliac disease symptoms.

What changed during the pandemic?

During the pandemic gut biopsies were discouraged, due to the high infection risk from attending hospital appointments. This prompted the British Society of Gastroenterology to publish interim guidelines on coeliac disease diagnosis.

These guidelines changed the recommendations for patients under 55 years old who were referred for a diagnosis of coeliac disease. If their blood tests gave a strong indication they were suffering with coeliac disease, they could be diagnosed without the need for a confirming biopsy (unless a biopsy was required to rule out other conditions).

This meant that patients with suspected coeliac disease could be diagnosed far sooner, and not have to suffer while they waited for further investigations.

How accurate are blood tests in coeliac disease diagnosis?

Studies have shown that using blood tests alone to diagnose coeliac disease is 98.7% accurate. In an interview with Radio 4’s Inside Health. Dr Hugo Penny, one of the authors of the interim guidance, described the traditional blood test and histology approach as ‘belt and braces’, when only a belt was really needed.

Can these tests be performed by a GP?

While the blood tests can be ordered by a GP, coeliac disease diagnosis, and the decision on whether or not to proceed with a biopsy, should still be made by a gastroenterologist. This means that the tests are considered by an expert in the context of any symptoms. It also means that the patient is under the care of gastroenterologist should they not respond to a gluten free diet and require further investigations.

Why is a diagnosis of coeliac disease so important?

Left untreated, coeliac disease can have serious consequences, such as malnutrition, mineral deficiencies and long-term damage to the gut. The sooner a patient starts a gluten free diet, the sooner their symptoms will improve.

What’s more, to help them follow a gluten free diet. Patients with coeliac disease are able to get certain gluten free foods on prescription from companies such as Glutafin. However, a formal diagnosis is required to access gluten free foods on prescription.

Is biopsy-free diagnosis the future for coeliac disease?

Although the peak of the pandemic has passed. The no-biopsy approach to coeliac disease diagnosis remains in place in the UK for patients under 55 who meet the criteria. With increasing evidence to back the no-biopsy approach, and growing pressure on NHS waiting lists. We may never go back to the belt and braces of biopsies.

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