Diagnosis and Management of Celiac Disease

The ACG recommends EGD with multiple duodenal biopsies for confirmation of diagnosis in both children and adults with suspicion of celiac disease (CD).

The ACG recommends case finding to increase detection of CD in clinical practice.

The ACG recommends against mass screening for CD in the community.

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.

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.

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.

The ACG recommends that testing for CD in children with IgA deficiency be performed using IgG-based antibodies (DGP-IgG or TTG-IgG).

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.

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.

The ACG suggests against the routine use of gluten detection devices in food or biospecimens among patients with CD.

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.