A Rubio-Tapia et al. Am J Gastroenterol 2023;118:59–76. Open Access! American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease Thanks to Ben Gold for this reference.
Here are some of the recommendations from updated ACG Celiac Guidelines:
Comments: The authors favor a non-biopsy approach for Celiac diagnosis in children with very elevated serology but not in adults. In adults, they cite a paucity of literature. “One multicenter international study of adults found that a 10-fold elevation of TTG IgA had a positive predictive value of 95% for CD (50). Given the life-long treatment implications of a GFD, this may be unacceptably low.”
The authors suggest assessing for mucosal healing after 2 years of treatment in all patients though they indicate a low quality of evidence for this recommendation. In those undergoing endoscopy, biopsies of the duodenal bulb along with at least 4 post-bulbar biopsies are recommended.
Figure 3 provides an algorithm for non-responsive celiac disease.
Related blog posts:
- What To Do For Pediatric Patients with Non-Responsive Celiac Disease
- Treatment of Refractory Celiac Symptoms with a Low FODMAP Diet
- Predicting Risk of Celiac Disease in High-risk Families
- Celiac Advocacy: Food Labeling Modernization Act
- Persistent Villous Atrophy in Celiac Disease Despite a Gluten-Free Diet
- Real-World = Partially-Treated Celiac Disease
- Best Screening For Celiac At All Ages
- Does The Degree of Villous Atrophy Affect Long-Term Outcomes with Celiac Disease? Plus One
- Study May Indicate Biologic Basis for Brain Fog in Persons with Celiac Disease
- @AmyOxentenkoMD: Celiac Disease and Mimics
- 99% Accuracy in Non-Biopsy Diagnosis of Celiac Disease
- Celiac Disease: “”80 percent of success is just showing up”