Diagnosis and Management of Celiac Disease
Official 2023 guideline of the American College of Gastroenterology.
Diagnosis
Diagnosis - All patients
The ACG recommends EGD with multiple duodenal biopsies for confirmation of diagnosis in both children and adults with suspicion of celiac disease (CD).
Strong recommendation
Moderate quality evidence
The ACG recommends case finding to increase detection of CD in clinical practice.
Strong recommendation
Low quality evidence
The ACG recommends against mass screening for CD in the community.
Strong recommendation
Low quality evidence
In adults unwilling or unable to undergo upper GI endoscopy, the ACG also suggests a combination of high-level TTG IgA (>10x upper limit of normal) with a postive EMA in a second blood sample as a diagnosis of likely CD.
Conditional recommendation
Moderate quality evidence
Diagnosis - Pediatrics
The ACG suggests a combination of high-level TTG IgA (>10x upper limit of normal) with a positive EMA in a second blood sample as reliable tests for diagnosis of CD in children.
Conditional recommendation
Moderate quality evidence
The ACG recommends the immunoglobulin IgA anti-TTGA-IgA as the preferred single test for detection of CD in children younger than 2 years old who are not IgA deficient.
Strong recommendation
Moderate quality evidence
The ACG recommends that testing for CD in children with IgA deficiency be performed using IgG-based antibodies (DGP-IgG or TTG-IgG).
Strong recommendation
Moderate quality evidence
Treatment
Dietary
The ACG suggests setting a goal of intestinal healing as an end-point of gluten-free diet (GFD) therapy and advocates for individualized discussion of goals of the GFD with the patient beyond clinical and surgical remission.
Conditional recommendation
Low quality evidence
The ACG recommends the consumption of gluten-free oats in the diet of those with CD. Gluten contamination of oats, variable toxicity in different varieties of oats, and the small risk for an immune reaction to the oat protein avenin requires monitoring for oat tolerance.
Strong recommendation
Moderate quality evidence
Monitoring
The ACG suggests against the routine use of gluten detection devices in food or biospecimens among patients with CD.
Conditional recommendation
Low quality evidence
Medication
There is insufficient evidence for the ACG to recommend for or against the use of probiotics for the treatment of CD.
The ACG suggests vaccination to prevent pneumococcal disease in patients with CD.
Conditional recommendation
Low quality evidence
What do the icons mean?
How strong is the ACG's recommendation?
Strong recommendation
Intervention's desirable effects clearly outweigh undesirable effects.Moderate recommendation
Further research likely to impact confidence in estimate of effect.
Conditional recommendation
Uncertainty in tradeoffs between desirable & undesirable effects of intervention.Weak recommendation
Uncertainty in tradeoffs between desirable & undesirable effects of intervention.
High quality evidence
Further research unlikely to change guideline authors' confidence in estimate of effect.
Moderate quality evidence
Further research likely to impact confidence in estimate of effect.Low quality evidence
Further research expected to have important impact in confidence in estimate of effect.Very low quality evidence
Effect is very uncertain.
