Coeliac disease

The incidence of coeliac disease remains high in the UK. This review describes the pathophysiology and presentation of children with coeliac disease. We discuss the new diagnostic process, which is now guided by the presence or absence of symptoms. New guidelines allow a secure diagnosis to be made in some children with the use of serological testing and genotyping, in place of duodenal biopsy.A lifelong gluten free diet remains the only treatment for coeliac disease. The best practice for the dietary and medical management of a gluten free diet is summarised and the importance of regular follow-up is discussed. This ensures long-term adherence and reduces the likelihood of associated complications. A supervised gluten challenge may be considered in some children, at the appropriate age, with a previous insecure diagnosis.