Celiac Disease Diagnosis, Management Guidelines Updated

Jessica Ganga

The American College of Gastroenterology (ACG) has updated its recommendations for diagnosing, evaluating, and managing celiac disease (CD).

Celiac disease, a permanent immune-mediated response to gluten, has a wide spectrum of clinical manifestations that resemble a multisystemic disorder, according to the guidelines.

The expert panel of researchers who are a part of the ACG created eight recommendations on a range of topics, from confirming a CD diagnosis to daily diet, as well as preventative care. The updated recommendations include:

  1. Using upper gastrointestinal endoscopy with multiple duodenal biopsies for confirming the presence of the disease in both children and adults.
  2. Noting that the endpoint of gluten-free diet therapy is intestinal healing and clinicians should create individualized goals for each of their patients.
  3. Staying away from gluten detection devices in food or biospecimens.
  4. Remarking on the fact that the use of probiotics for patients with CD lacks sufficient evidence to strongly recommend its use.
  5. Including gluten-free oats as part of one’s diet for those with CD.
  6. Receiving the pneumococcal vaccine to prevent infection in those with CD.
  7. Using case finding to increase detection of CD in clinical practice. The use of mass screening for CD in the community is not recommended.
  8. For patients aged 2 years and younger, immunoglobulin IgA anti-TTG is the preferred single test for CD detection, and testing for CD in children with IgA should be performed using IgG-based antibodies.

“These guidelines are established to support clinical practice and suggest preferable approaches to a typical patient with a particular medical problem based on the currently available published literature,” the researchers wrote. “When exercising clinical judgment, particularly when treatments pose significant risks, healthcare providers should incorporate this guideline in addition to patient-specific medical comorbidities, health status, and preferences to arrive at a patient-centered care approach.”



Rubio-Tapia A, Hill I, Semrad C, Kelly CP, Lebwohl B. American College of Gastroenterology guidelines update: diagnosis and management of celiac disease. Am J Gastroenterol. 2023;118(1):59-76. doi:10.14309/ajg. 0000000000002075