Objective Coeliac disease (CD) is a lifelong condition requiring strict adherence to a gluten-free (GF) diet and good availability of GF foods is critical to this. Patients with CD from lower socioeconomic groups are recognised to have higher treatment burden and higher food costs may impact this. Therefore, we aimed to assess the availability and cost of GF food in supermarkets and via the internet. Design Supermarkets and internet shops delivering to homes in a single city (UK) were analysed between February and March 2014. Stores were identified with comprehensive internet searches. Ten commonly purchased items were analysed for cost and compared with standard non-GF alternatives. Direct measurement of the number of GF foods available was compared between stores which were categorised according to previously published work. Setting Supermarkets covering the whole of Sheffield, UK. Results None of the budget supermarkets surveyed stocked any GF foods. Quality and regular supermarkets stocked the greatest range, each stocking a median of 22 (IQR 39) items (p<0.0001). All GF foods were at least four times more expensive than non-GF alternatives (p<0.0001). GF products are prevalent online, but 5/10 of the surveyed products were significantly more expensive than equivalents in supermarkets. Conclusions There is good availability of GF food in regular and quality supermarkets as well as online, but it remains significantly more expensive. Budget supermarkets which tend to be frequented by patients from lower socioeconomic classes stocked no GF foods. This poor availability and added cost is likely to impact on adherence in deprived groups.

#### Summary points Coeliac disease is a common autoimmune condition characterised by a heightened immunological response to ingested gluten, with estimated prevalence rates in adults of 0.2-1% in the United States and Europe. 1 2Contemporary studies suggest that the prevalence of this disease is increasing.3 4 5 Meta-analyses have shown that for every patient identified as having coeliac disease seven to eight remain undiagnosed.6 7 Here, we will summarise recent evidence on how the investigation and diagnosis of coeliac disease can be improved and also provide an evidence based approach to managing patients with newly diagnosed coeliac disease and those who do not respond to a gluten-free diet as expected. Evidence is taken from meta-analyses, systematic reviews, and randomised controlled trials where possible. #### Sources and selection criteria We searched Medline and the Cochrane Database of Systematic Reviews with the search terms “coeliac disease” or “celiac disease”. Studies included those in adult and paediatric populations but preference was given to adult studies in the past five years. We focused on meta-analyses and systematic reviews where possible. In the past coeliac disease was considered to be a disease that affects white populations only, but it is now clear that coeliac disease is a …