Current RMA Instruments
| Reasonable Hypothesis SOP | 29 of 2020 |
| Balance of Probabilities SOP | 30 of 2020 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 579.0
- ICD-10-AM Codes: K90.0
Brief description
Coeliac disease is an immune-mediated disease of the small bowel, in which sensitivity to dietary gluten leads to mucosal changes, malabsorption, diarrhoea and other gastrointestinal and systemic symptoms. It needs to be distinguished from "gluten intolerance" / non-coeliac gluten sensitivity, which does not have the pathological findings seen in coeliac disease.
Confirming the diagnosis
The diagnosis can be effectively excluded in some people based on history (including family history and ethnicity) and serological testing. In people with a high probability of coeliac disease, both small bowel histology (from endoscopic biopsy, while on a gluten containing diet) and serology are needed for diagnosis.
The relevant medical specialist is a gastroenterologist.
Additional diagnoses covered by SOP
- Coeliac crisis
- Gluten sensitive enteropathy
- Non-tropical sprue
Conditions not covered by SOP
- Irritable bowel syndrome*
- Lactose intolerance#
- Non-coeliac gluten sensitivity#
- Non-coeliac wheat protein sensitivity#
- Tropical sprue#
- Wheat allergy#
* another SOP applies
# non-SOP condition
Clinical onset
Onset for classical coeliac disease is in infancy. Increasingly, the condition presents between ages 10 and 40. Symptoms are variable but include chronic or recurrent diarrhoea or constipation, malabsorption, unexpected weight loss, abdominal pain, distension, or bloating. Numerous extraintestinal manifestations may also occur.
Clinical worsening
The mainstay of management is maintaining a gluten-free diet. Worsening may be evidenced by a deterioration in symptoms, the development of features of malabsorption (including nutritional deficiencies), or changes seen on regular serological monitoring.