Positive endomysium antibodies (EmA) and high concentrations of tissue transglutaminase antibodies (tTG) have excellent accuracy for coeliac disease. The updated guideline recommends using tTG as the first-line diagnostic investigation. Diagnosis can be made without endoscopy in subjects with tTG >10x upper limit of normal and positive EmA; in other cases intestinal biopsy is needed. Skin biopsy is required for the diagnosis of dermatitis herpetiformis. The treatment is a life-long gluten-free diet initiated under the supervision of a dietitian. The possibility of refractory coeliac disease should be remembered particularly in older persons and in those with inadequate dietary response.
Katri Kaukinen (Chair)