Coeliac disease: testing and follow-up
Short patient information to print or keep.
Confirm before changing your diet
Coeliac disease is a lifelong immune condition, not simply an intolerance. Keep eating gluten until your clinical team has completed the diagnostic plan. Feeling better without wheat does not establish the diagnosis.
Blood tests
The usual first tests are tTG-IgA and total IgA. Low IgA needs a different approach. Negative antibodies are less reliable after gluten restriction. A positive result needs an agreed diagnostic assessment.
Gastroscopy and biopsies
Gastroscopy samples the duodenum, which can look normal despite microscopic changes. I review the actual antibody result, symptoms and any other reason for gastroscopy before agreeing the diagnostic approach with you.
Already gluten-free?
Bring old results and explain how long you have avoided gluten. Gene testing can sometimes help exclude coeliac disease, but a positive gene test does not diagnose it. Any gluten challenge needs an agreed plan.
After diagnosis
Treatment is a strict lifelong gluten-free diet, supported by a dietitian and Coeliac New Zealand. Review nutrition, deficiencies, bone health and family testing. Symptoms can improve before the lining has healed.
Continue follow-up
Review symptoms, weight, diet, antibodies and deficiencies together. Normal antibodies do not prove healing. The endoscopy and/or histology report documents recommended follow-up after biopsies. New weight loss, continuing anaemia or worsening pain need review.
When to seek advice
Arrange prompt medical review for unexplained weight loss, persistent vomiting, worsening pain, bleeding or continuing iron deficiency. These changes should not simply be attributed to coeliac disease or gluten exposure.
Severe pain, vomiting blood, black tarry stools with faintness or collapse need urgent assessment. Call 111 if you collapse or are too unwell to travel safely.
General information. Follow your own care instructions.