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Diagnosis Information

Coeliac disease (CD) is a serious medical condition with lifelong complications and a conclusive diagnosis is vital for its management.

Tests available

As coeliac disease (CD) is a serious medical condition with lifelong complications, a conclusive diagnosis is vital for its management. There are a number of tests available to diagnose coeliac disease. If you are an adult, you can refer to our adult diagnostic pathway card for more information.

For children, Starship Children’s Health and Coeliac New Zealand have created a unique partnership to offer better community support and care for children with coeliac disease. This has included the development of a new regional clinical pathway, for children who live in the Auckland, Waitemata and Counties Manukau District Health Board regions. Download the Auckland Region Paediatric Clinical Pathway here.

TESTS AVAILABLE FOR COELIAC DISEASE:

Coeliac serology:
Confirm your patient is consuming a gluten containing diet for accurate results. Request coeliac disease serology specifically: IgA-tTG (tissue transglutaminase), +/- Endomysial antibodies, and +/- Deamidated gliadin peptide antibodies (will depend on local laboratory).
Gene testing:

HLA DQ2/DQ8Gene (HLA) testing is a useful tool in cases when the diagnosis of coeliac disease is not conclusive.

Over 99% of people affected by coeliac disease possess specific susceptibility genes (HLA DQ2 and/or HLA DQ8). Either one or both of these genes are present in virtually every person with coeliac disease. Various environmental factors are thought to play an important role in the triggering or "unmasking" of coeliac disease in infancy, childhood or even later in life.

The gene test does not rely on a person eating gluten so can be used when people have already commenced a gluten free diet and find it very difficult to do a gluten challenge.

A positive gene test is not a diagnosis of CD. If the gene test is positive for HLA DQ2 or HLA DQ8, then a gluten challenge followed by a small bowel biopsy will be required to diagnose coeliac disease. A biopsy/endoscopy remains the gold standard for diagnosis at this point in time.

FOLLOWING A GF DIET PRIOR TO TESTING?

The 2 Options

Option 1: Recommend a gluten challenge. If gluten has already been removed from the diet, a normal gluten containing diet must be resumed for at least 4-6 weeks prior to serology testing and biopsy (refer to the diagnostic card). During this ‘gluten challenge’, a minimum of four slices of wheat based bread (or equivalent) should be consumed each day for 4 weeks, by adults.

Two slices of wheat based bread each day for children, or gluten in at least two meals/day for 4-6 weeks. It is important the gluten challenge is carried out properly to ensure reliable test results.

Option 2: If your patient is reluctant or unable to complete a gluten challenge, offer HLA-DQ2/ 8 gene testing. If HLA DQ2/ 8 gene testing is negative coeliac disease can be safely excluded. If it is positive, then option 1 is the only diagnostic approach.

SYMPTOMS OF COELIAC DISEASE

POINT OF CARE TESTING:

Coeliac NZ has sought specialist advice on the suitability and reliability of Point of Care Testing (PoCT) now available in NZ pharmacies. Our current stance is that we do not recommend PoCTs are adopted in routine clinical practice until further evidence is produced. For further information, please refer to our PoCT page.

"By taking the first step to gain a diagnosis, you can be confident that your symptoms are caused by CD. You can, therefore, receive the necessary support, information, and means to thrive on a gluten free diet."

A gluten free diet is not a negligible nor simple undertaking, as it brings about lifestyle changes and learning new skills such as reading and interpreting food labels. It should only be undertaken after the diagnosis of coeliac disease has been definitively and medically confirmed.

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LEARNING RESOURCES

Access the online course for Physicians & Dietitians developed by the Division for Pediatric Gastroenterology & Hepatology, Munich, Germany.

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ABOUT COELIAC NEW ZEALAND

Your partner in
healthy living

Coeliac New Zealand is available throughout your journey. As part of our community, you’ll get support, advice, and assistance. We work with health professionals, manufacturers, and researchers to raise awareness of coeliac disease in NZ.

Together, we can reach a day when every person with coeliac disease gets diagnosed quickly, lives a healthy life, and has the prospect of a cure.

LATEST NEWS

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Auckland University student, Tayla Eveleigh is helping Coeliac NZ better understand the current dining out habits and limitations of people following a strict gluten free diet. The dining out scene has experienced significant growth over the past few years. People no longer only look to eat out for ease and convenience, but largely center social […]

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25/03/2020
Tips for self-isolation – by Nicole Wilson

A Coeliac NZ member shares advice for staying well in self-isolation.... I was recently privileged enough to go on a wonderful family holiday with Hubby, my father and my brother + wife. In the past family holidays have all been NZ-based. Growing up it was usually in a camping ground in some far-flung corner of […]

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23/03/2020
Covid-19 coronavirus update

We are aware there is a lot of concern with the current situation around COVID-19 and how this affects people with coeliac disease (CD). Coeliac NZ's advice with the support of our Medical Advisory Panel is that being more cautious is not going to be damaging to you. As coronavirus is a new illness, there […]

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