# Coeliac Disease (Referral & Supportive Care) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ESPGHAN Guidelines for Diagnosis of Coeliac Disease 2020 · Egyptian National Drug Formulary - Blood Disorder Medications 2025 (folic acid monograph) · Egyptian National Drug Formulary - Blood Disorder Medications 2025 (ferrous fumarate monograph) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Blood Disorder Medications 2025 (ferrous fumarate monograph) - Egyptian National Drug Formulary - Blood Disorder Medications 2025 (folic acid monograph) ## Treatment metadata - Ferrous fumarate — 200 mg — oral.solid - Folic acid — 5 mg — oral.solid ## Complete treatment card ```text COELIAC DISEASE (REFERRAL & SUPPORTIVE CARE) Sources: ESPGHAN Guidelines for Diagnosis of Coeliac Disease 2020 · Egyptian National Drug Formulary - Blood Disorder Medications 2025 (folic acid monograph) · Egyptian National Drug Formulary - Blood Disorder Medications 2025 (ferrous fumarate monograph) Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (10) - Adults: the hallmarks are diarrhoea and weight loss with no explanation [diarrhoea · weight loss] - Adults also report a swollen abdomen, bloating, discomfort, nausea, vomiting, fatty stools or constipation [abdominal distension · constipation · nausea · steatorrhoea · vomiting] - Children: poor weight gain, with reduced appetite, irritability and diarrhoea [diarrhoea · failure to thrive · irritability · poor appetite] - Parents may describe a swollen tummy, vomiting or constipation [constipation · vomiting] - Tiredness, pallor and breathlessness point to anaemia from poor iron, folate and B12 absorption [anaemia · breathlessness · fatigue · pallor] - Adults may report weak muscles, pins and needles, unsteadiness and long-standing headaches [muscle weakness · tingling · unsteadiness] - Joint pain, muscle pain and bone pain occur at any age [bone pain · joint pain · muscle pain] - Adults may have broken bones on a background of thin bone - Infertility and repeated miscarriage have been linked to it [infertility] - In children, short stature, damaged tooth enamel and late puberty follow the malnutrition [short stature] SIGNS - what you find (4) - Low weight with wasted muscle - A distended or tender abdomen, weak muscles, and tenderness over joints or bones [abdominal tenderness · muscle weakness] - Pallor from anaemia, cracked lip corners or a sore smooth tongue from vitamin lack, and skin rashes [anaemia · pallor] - Dermatitis herpetiformis, a fiercely itchy blistering rash, is diagnostic even with no gut symptoms [itching · rash] TESTS (12) - First test is tissue transglutaminase IgA in anyone not IgA-deficient - The patient must still be eating gluten, for at least 6 to 8 weeks before the test - Measure total IgA at the same time if it has never been checked; use IgG-based tests where IgA is deficient - A negative antibody largely rules it out where IgA is normal and suspicion is low to moderate - Where suspicion is high, as in a child failing to grow, a negative antibody may still be wrong - Endomysial antibody settles borderline or equivocal results, but costs more and is laborious - The genetic test suits someone already off gluten who cannot restart it - A negative gene test excludes it almost certainly; a positive one shows only susceptibility, as 30 to 40 in 100 people carry it - A raised antibody is followed by endoscopy with several duodenal biopsies, in children and adults alike - Take one or two samples from the duodenal bulb and four from further down, to cut false negatives - Confirmatory microscopy: flattened villi, deepened crypts, and lymphocytes within the lining - Test relatives and those with type 1 diabetes, autoimmune thyroid or liver disease, Down or Turner syndrome IF NOT THIS - what else fits (12) - Non-coeliac gluten sensitivity looks the same and also improves off gluten - Irritable bowel syndrome: abdominal pain and cramp, diarrhoea, constipation and bloating - Crohn disease or ulcerative colitis, with abdominal discomfort, diarrhoea and weight loss - Lactose intolerance, which can be a consequence of the flattened villi or stand alone - Bacterial overgrowth of the small bowel: bloating, diarrhoea, wind, nausea, tiredness and weight loss - Food allergy or intolerance, fructose intolerance among them - Autoimmune enteropathy, rare and severe, with diarrhoea and near-identical biopsy changes - Tropical sprue, which also flattens the villi but answers to antibiotics - Giardiasis gives the same biopsy picture; seeing the trophozoites on the villi tells them apart - Pancreatic insufficiency, with malabsorption and fatty stools - Drug-induced gut damage: anti-inflammatory painkillers, olmesartan, chemotherapy, immunosuppressants, antibiotics - In children also cow milk protein allergy, reflux disease, cystic fibrosis and wheat allergy Source StatPearls "Celiac Disease" - disease-level clinical article Status traced to the source above 1. FERROUS FUMARATE [1st line] Adult 200 mg once or twice a day x 3-6 months until iron stores replenished Peds 3-6 mg/kg/day [child max 180 mg] (Divided into 2-3 doses daily; elemental iron basis. Ceiling of 180 mg is the formulary maximum for a child: 20 mL/day of the 140 mg/5 mL syrup, which is 45 mg elemental iron per 5 mL. This is deliberately above the 130 mg an adult gets here: a growing child needs more elemental iron per kilogram, and modern adult practice is lower and less frequent dosing than the formulary allows. It is not an inversion to correct.) 3kg -> 9-18 mg/day 4kg -> 12-24 mg/day 5kg -> 15-30 mg/day 6kg -> 18-36 mg/day 7kg -> 21-42 mg/day 8kg -> 24-48 mg/day 9kg -> 27-54 mg/day 10kg -> 30-60 mg/day 11kg -> 33-66 mg/day 12kg -> 36-72 mg/day 13kg -> 39-78 mg/day 14kg -> 42-84 mg/day 15kg -> 45-90 mg/day 16kg -> 48-96 mg/day 17kg -> 51-102 mg/day 18kg -> 54-108 mg/day 19kg -> 57-114 mg/day 20kg -> 60-120 mg/day 21kg -> 63-126 mg/day 22kg -> 66-132 mg/day 23kg -> 69-138 mg/day 24kg -> 72-144 mg/day 25kg -> 75-150 mg/day 26kg -> 78-156 mg/day 27kg -> 81-162 mg/day 28kg -> 84-168 mg/day 29kg -> 87-174 mg/day 30kg -> 90-180 mg/day 31kg -> 93-180 mg/day (upper capped) 32kg -> 96-180 mg/day (upper capped) 33kg -> 99-180 mg/day (upper capped) 34kg -> 102-180 mg/day (upper capped) 35kg -> 105-180 mg/day (upper capped) 36kg -> 108-180 mg/day (upper capped) 37kg -> 111-180 mg/day (upper capped) 38kg -> 114-180 mg/day (upper capped) 39kg -> 117-180 mg/day (upper capped) 40kg -> 120-180 mg/day (upper capped) 41kg -> 123-180 mg/day (upper capped) 42kg -> 126-180 mg/day (upper capped) 43kg -> 129-180 mg/day (upper capped) 44kg -> 132-180 mg/day (upper capped) 45kg -> 135-180 mg/day (upper capped) 46kg -> 138-180 mg/day (upper capped) 47kg -> 141-180 mg/day (upper capped) 48kg -> 144-180 mg/day (upper capped) 49kg -> 147-180 mg/day (upper capped) 50kg -> 150-180 mg/day (upper capped) Source Egyptian National Drug Formulary - Blood Disorder Medications 2025 (ferrous fumarate monograph) Why Iron and folate are both malabsorbed in untreated coeliac disease, so the folic acid in most Egyptian iron tablets is an advantage here rather than something to work around. Dose by elemental iron: a 200 mg ferrous fumarate tablet is 65.57 mg. Caution Definitive treatment is strict lifelong gluten-free diet. Refer to gastroenterologist for duodenal biopsy or serological confirmation. Do not start gluten-free diet before diagnostic serology/biopsy. Children under 12 take the syrup: 0.5 mL/kg/day split into two or three doses, never above 20 mL a day. A premature infant under 3 kg gets 0.5 mL a day. The formulary gives 200 mg two to three times daily. The dose here deliberately sits lower - once daily or alternate days - because a smaller, less frequent dose is absorbed as well and tolerated far better. Most iron tablets in Egypt come with folic acid in them, though not all - check the pack. Folate corrects the blood picture of B12 deficiency while the neurological damage carries on - check B12 before starting if the anaemia is macrocytic, mixed, or unexplained. The pack a pharmacy hands over is a combination rather than plain iron - besides folic acid, many Egyptian iron products add vitamin C, and some add zinc or B vitamins. A combination is an acceptable way to give oral iron: the formulary's ferrous fumarate monograph lists the dosage forms as a 200 mg tablet and a 140 mg/5 mL syrup, then adds combination products to that list, and states the adult dose in elemental iron (100 to 200 mg elemental iron daily). The vitamin C is wanted rather than merely tolerated - 200 to 500 mg alongside oral iron is recommended to enhance its absorption. Dose by the elemental iron the pack states, not by tablet weight and not by the other ingredients. The Egyptian register does not record elemental iron content for most of these products, so the carton has to be read. Egypt FERROL 10 F.C. TABLET AMOUN 2.00 EGP (0.20/unit) -> ! also contains folic acid FOLIFER 30 TAB. MISR 7.20 EGP (0.24/unit) -> ! also contains folic acid FERROZINC-C 24 CAPS. SAFE PHARMA >... 7.50 EGP (0.31/unit) -> ! also contains vitamin c, zinc IROFOL 30 CAPS. MULTICARE 40.50 EGP (1.35/unit) -> ! also contains copper, folic acid, pyridoxine, vitamin b12, zinc HAEMACTIN 30 CAPS. DELTA GRAND P... 150.00 EGP (5.00/unit) -> ! also contains folic acid, vitamin b12 TESLAGLOBIN 20 CAP DAWA EGYPT IN... 140.00 EGP (7.00/unit) -> ! also contains b12, b6, copper, folic acid, zinc CHEMARED CAPSULE PHARMA ZAD > ... 195.00 EGP -> ! also contains calcium, methyl cobolamine, pyridoxine FERRONIL 125MG/5ML SYRUP 120 ML EL NILE. 4.00 EGP -> ? strength differs, ? different route - not oral solid 2. FOLIC ACID [add-on - not a substitute] Adult 5 mg once daily x 4 months Peds Children: 2.5-5 mg once daily Source Egyptian National Drug Formulary - Blood Disorder Medications 2025 (folic acid monograph) Why Adjunct supplement that corrects the folate malabsorption caused by duodenal villous atrophy in coeliac disease; it does not replace the gluten-free diet, which is the underlying treatment. Caution Corrects folate malabsorption secondary to duodenal villous atrophy. Exclude Vitamin B12 deficiency before giving high-dose folic acid. Re-evaluate mucosal healing if anaemia fails to resolve on gluten-free diet. Egypt FOLIC ACID (EL NILE) 5 MG 50 TAB. EL NILE. 26.25 EGP (0.53/unit) FOLIC ACID (MEMPHIS) 5 MG 30 TAB. MEMPHIS 15.75 EGP (0.53/unit) FOLICINAD 5 MG 50 TABS. INAD PHARMA 50.00 EGP (1.00/unit) FOLIC ACID (EIPICO) 5 MG 20 TAB. EIPICO 24.00 EGP (1.20/unit) FOLIC ACID (EL NILE) 5 MG 30 TAB. EL NILE. 36.00 EGP (1.20/unit) FOLIRAQ 5000 MCG 30 CAPSULES HP PHARMA 45.00 EGP (1.50/unit) FOLIDDOX 400 MCG / 5 ML LIQUID 150 ML MADDOX PHARMA 150.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)