Children with type 1 diabetes and Down syndrome should be more actively screened for coeliac disease, experts say.
A review of diagnosis and management of the the disease - in which the immune system reacts abnormally to eating gluten - has been published in the Medical Journal of Australia.
The latest estimates show coeliac disease in Australia affects an estimated one in 86 adult men (1.2 per cent) and one in 52 women (1.9 per cent).
It can lead to nutritional deficiency if left undiagnosed and untreated.
There is also a small long-term risk of gastrointestinal malignancy, the paper warns.
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The authors of the MJA paper - led by Professor Marjorie Walker, a professor of anatomical pathology at the University of Newcastle - say this makes the case for greater surveillance of high-risks groups "compelling".
"Recent studies show that children with diabetes mellitus type 1 and Down syndrome have a high prevalence of coeliac disease, which may present with abdominal pain and constipation rather than classical diarrhoea -- also pointing to case finding in this group," the authors wrote.
"Although current evidence is not sufficient to support mass screening for coeliac disease, active case-finding is very appropriate in high-risk groups," the authors wrote.
The review has also highlighted the importance of regular follow-up of patients who must adhere to a gluten-free diet.
"Follow-up should also include bone density measurements after one year of a gluten-free diet in patients with additional risk factors for osteoporosis or who are aged 55 years or over," the authors wrote.
"A gluten-free diet is a core management strategy for osteoporosis prevention."
