One would have thought that the Canterbury study1 and Mark Lane’s accompanying editorial2 (both in the 20 February 2004 issue of the Journal) should have dispelled the notion that coeliac disease is rare in New Zealand. In fact, the prevalence here is reported to be one of the highest (1:83) in the Western World.

However it seems that there still is little awareness of the adult onset coeliac disease. We continue to come across these patients who have been misdiagnosed as either ‘refractory iron deficiency anaemia’ or ‘irritable bowel syndrome’. One patient was even labelled as a ‘hypochondriac’. And a couple of patients were diagnosed 30 to 40 years after the onset of their symptoms!

Our experience is that the GPs are not the only group at fault here. We have observed the same lack of awareness even among the hospital staff. It is not uncommon to come across patients with chronic refractory iron deficiency anaemia who have been referred to the endoscopy department and scoped ‘top and bottom’ but no duodenal biopsies taken to rule out coeliac disease. Although the macroscopic features of coeliac disease on endoscopy are well known, none are pathognomonic, and biopsies are mandatory. Dual pathology in patients scoped for iron deficiency anaemia are also not uncommon3 and we think it is a good practice that, in high prevalence areas like New Zealand, duodenal biopsies should be taken as a routine in such cases.4

Also, before labelling iron deficiency anaemia as ‘menstrual related’ in young and middle-aged females, a simple serological screening test for coeliac disease should be performed.