Introduction:
Coeliac disease (CeD) is underdiagnosed and its follow-up remains poorly standardised, with limited multidisciplinary support and considerable variation in care across healthcare systems. Despite international recommendations for diagnosis and management, no formal framework defines essential components of a high-quality CeD service. We aimed to establish consensus-based quality standards for Comprehensive Care Units for CeD.
Methods:
A national multidisciplinary Delphi process was conducted between January and June 2025 led by the Spanish Society for Celiac Disease, with collaboration of the major Spanish societies of adult and paediatric gastroenterology. An expert committee comprising specialists in adult and paediatric gastroenterology, laboratory medicine, biomedical research, and dietetics developed a standards framework informed by literature, clinical expertise, and patient priorities. A multidisciplinary panel of 19 stakeholders, including gastroenterologists, laboratory specialists, pathologists, dietitians, psychologists, researchers, and patients or caregivers nominated by the three major Spanish coeliac patient organisations, participated in two Delphi rounds. Standards were organised into structural, process, and scientific-educational domains. Consensus was assessed using mean agreement scores and coefficients of variation (CV).
Results:
All participants completed both Delphi rounds. The process generated 39 quality standards comprising 18 structural, 16 process, and 5 scientific-educational standards. Structural standards defined requirements for multidisciplinary staffing, specialist dietetic and psychological support, diagnostic infrastructure, and organisational leadership. Process standards established pathways for optimized diagnosis, nutritional assessment, vaccination monitoring, management of non-responsive CeD, transition of care, and long-term follow-up. Scientific-educational standards promoted patient registries, biobanks, research activity, and professional education. Thirty-eight of 39 standards achieved very high consensus and one high consensus (overall mean CV was 9.1%).
Conclusion:
This multidisciplinary consensus establishes the first comprehensive quality framework for CeD care units. By translating guideline recommendations into measurable service standards, it provides a practical model for centres of excellence, accreditation programmes, and international efforts to standardise and improve CeD care worldwide.