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Coeliac Disease J019

Last amended 
5 May 2020
Current RMA Instruments
Reasonable Hypothesis SOP
29 of 2020
Balance of Probabilities SOP
30 of 2020
Changes from previous Instruments

SOP bulletin 214

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.