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Updated clinical guidelines for diagnosis and management of coeliac disease

Dr Alberto Rubio-Tapia from the Cleveland Clinic, Ohio, USA
American Journal of Gastroenterology

The American College of Gastroenterology has updated its guidelines for the diagnosis and management of coeliac disease, defined as a permanent immune-mediated response to gluten present in wheat, barley, and rye. The updated guidelines are published in the 2023 January issue of the American Journal of Gastroenterology [1].

A team of experts, led by Dr Alberto Rubio-Tapia from the Cleveland Clinic, Ohio, USA, formulated updated recommendations around 8 key topics that healthcare providers frequently face in the diagnosis and management of patients with coeliac disease. The updated recommendations include:

  1. Diagnosis: Multiple duodenal biopsies for confirming the presence of coeliac disease in children and adults are recommended, which can also be useful for the differential diagnosis of other malabsorptive disorders or enteropathies.
  2. Diet and long-term outcomes: Clinicians should establish individualised goals for patients with coeliac disease to achieve the therapeutic goals of intestinal healing. Follow-up biopsy could be considered to assess achievement of mucosal healing in adults that are symptom-free after two years of starting a gluten-free diet.
  3. Medical devices: Routine use of technologies such as gluten detection devices are not recommended as these may not be able to differentiate between clinically significant and trivial gluten exposure.
  4. Probiotics: there is a paucity of evidence to recommend for or against the use of probiotics for the treatment of coeliac disease.
  5. Nutrition: For most patients with coeliac disease, gluten-free oats can be included as part of their diet, but it may be immunogenic for a subset of patients. The standard of care should involve an interview with a dietician with expertise in gluten-free diet.
  6. Pneumococcal vaccine: it is recommended to provide pneumococcal vaccination to prevent pneumococcal disease in patients with coeliac disease.
  7. Screening: Case finding in patients with signs, symptoms and laboratory evidence suggestive of malabsorption as well as testing of asymptomatic relatives with a first-degree family member with a confirmed diagnosis of coeliac disease are suggested to increase detection of coeliac disease in clinical practice. The use of mass screening for coeliac disease, however, is not recommended.
  8. Testing in children: the immunoglobulin IgA anti-TTG antibody test is recommended as the preferred single test for the detection of coeliac disease in children aged 2 years and younger.

The experts stated: “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. 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.”

For further information, read the complete journal article here:

  1. Rubio-Tapia A, et al. Am J Gastroenterol. 2023;118(1):59-76. DOI: 14309/ajg.0000000000002075

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