American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease
Rubio-Tapia, Alberto et al.
Abstract
This guideline presents an update to the 2013 American College of Gastroenterology Guideline on the Diagnosis and Management of Celiac Disease with updated recommendations for the evaluation and management of patients with celiac disease (CD). CD is defined as a permanent immune-mediated response to gluten present in wheat, barley, and rye. CD has a wide spectrum of clinical manifestations that resemble a multisystemic disorder rather than an isolated intestinal disease, and is characterized by small bowel injury and the presence of specific antibodies. Detection of CD-specific antibodies (e.g., tissue transglutaminase) in the serum is very helpful for the initial screening of patients with suspicion of CD. Intestinal biopsy is required in most patients to confirm the diagnosis. A nonbiopsy strategy for the diagnosis of CD in selected children is suggested and discussed in detail. Current treatment for CD requires strict adherence to a gluten-free diet (GFD) and lifelong medical follow-up. Most patients have excellent clinical response to a GFD. Nonresponsive CD is defined by persistent or recurrent symptoms despite being on a GFD. These patients require a systematic workup to rule out specific conditions that may cause persistent or recurrent symptoms, especially unintentional gluten contamination. Refractory CD is a rare cause of nonresponsive CD often associated with poor prognosis.
INTRODUCTION
Guiding principles
This document presents official recommendations from the American College of Gastroenterology (ACG) on the diagnosis, management, and follow-up of celiac disease (CD) in children and adults. This guideline was developed in compliance with the Institute of Medicine standards for practice guidelines and uses the Grading of Recommendation Assessment Development and Evaluation (GRADE) approach. The primary objective is to produce high-quality evidence-based clinical practice guidelines to answer common clinical questions and improve health care.
The guideline evaluates a broad spectrum of clinical practice, including indication for CD testing; diagnostic strategies for individuals on a gluten-containing diet or following a gluten-free diet (GFD); role of biopsy for confirmation of the diagnosis; indication for gluten challenge and genetic testing; general approach to management; preventive care such as vaccination; monitoring of GFD adherence including discussion of gluten detection devices, probiotics, goals of therapy, and outcomes; and the differential diagnosis for nonresponsive CD.
The guideline developers from ACG identified key questions that providers face frequently in the diagnosis, management, and follow-up of patients with CD (Tables 1 and 2). This guideline is intended for healthcare providers who care for patients with CD.
