European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders
Open accessAbstract
This guideline presents recommendations for the management of coeliac disease (CD) and other gluten-related disorders both in adults and children. There has been a substantial increase in the prevalence of CD over the last 50 years and many patients remain undiagnosed. Diagnostic testing, including serology and biopsy, should be performed on a gluten-containing diet. The diagnosis of CD is based on a combination of clinical, serological and histopathological data. In a group of children the diagnosis may be made without biopsy if strict criteria are available. The treatment for CD is primarily a gluten-free diet (GFD), which requires significant patient education, motivation and follow-up. Slow-responsiveness occurs frequently, particularly in those diagnosed in adulthood. Persistent or recurring symptoms necessitate a review of the original diagnosis, exclude alternative diagnoses, confirm dietary adherence (dietary review and serology) and follow-up biopsy. In addition, evaluation to exclude complications of CD, such as refractory CD or lymphoma, should be performed. The guideline also deals with other gluten-related disorders, such as dermatitis herpetiformis, which is a cutaneous manifestation of CD characterized by granular IgA deposits in the dermal papillae. The skin lesions clear with gluten withdrawal. Also, less well-defined conditions such as non-coeliac gluten sensitivity (NCGS) and gluten-sensitive neurological manifestations, such as ataxia, have been addressed. Newer therapeutic modalities for CD are being studied in clinical trials but are not yet approved for use in practice.
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Tissue transglutaminase IgA is 98% sensitive and specific for coeliac disease.
“Tissue transglutaminase IgA is 98% sensitive and specific for coeliac disease, however intestinal biopsy is recommended to confirm the diagnosis.727”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [727]
Five CPGs for populations with celiac disease [[52], [53], [54], [55], [56]] recommended complete avoidance of gluten, but gluten was not mentioned by any other CPG.
“Five CPGs for populations with celiac disease [[52], [53], [54], [55], [56]] recommended complete avoidance of gluten, but gluten was not mentioned by any other CPG.”
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Yuan, S., Jiang, F., Chen, J., Lebwohl, B., Green, P. H. R., Leffler, D. A., Larsson, S. C., Li, X., & Ludvigsson, J. F. (2024) · EBioMedicine · doi:10.1016/j.ebiom.2024.105033 · Cited by 34 · see citing works
“46 These recommendations are supported by two earlier meta-analyses.”
BackgroundMethodInfluentialQuality of Life and Psychological Disorders in Coeliac Disease: A Prospective Multicentre Study
Canova, C., Rosato, I., Marsilio, I., Valiante, F., Zorzetto, V., Cataudella, G., D’Odorico, A., & Zingone, F. (2021) · Nutrients · doi:10.3390/nu13093233 · Cited by 34 · see citing works
“No patient underwent a follow-up upper endoscopy, as suggested by the recent guidelines, since none had any suspected complications [32].”
Backgroundde Eguino, L. C.-R., Salmerón, J., Miranda, J., Larretxi, I., Fernández-Gil, M. D. P., Bustamante, M. Á., Matias, S., Navarro, V., Simón, E., & Martínez, O. (2022) · Applied Sciences · doi:10.3390/app12125934 · Cited by 34 · see citing works
Meijer-Boekel, C. R., Shamir, R., Szajewska, H., & Mearin, M. L. (2018) · Frontiers in Pediatrics · doi:10.3389/fped.2018.00368 · Cited by 33 · see citing works
Gut Microbiota Alteration and Its Modulation with Probiotics in Celiac Disease
Saviano, A., Petruzziello, C., Brigida, M., Loprete, M. R. M., Savioli, G., Migneco, A., & Ojetti, V. (2023) · Biomedicines · doi:10.3390/biomedicines11102638 · Cited by 33 · see citing works
Non-Responsive and Refractory Coeliac Disease: Experience from the NHS England National Centre
Penny, H. A., Rej, A., Baggus, E. M., Coleman, S. H., Ward, R. Y., Wild, G., Bouma, G., Trott, N., Snowden, J. A., Wright, J., et al. (2022) · Nutrients · doi:10.3390/nu14132776 · Cited by 33 · see citing works
Self-citationFernández‐Bañares, F., Carrasco, A., Martín‐Cardona, A., & Esteve, M. (2019) · Nutrients · doi:10.3390/nu11091992 · Cited by 33 · see citing works
“The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for the Study of Coeliac Disease (ESsCD) guidelines suggest that in doubtful cases, a high CD3+ T-cell receptor gamma delta+ (TCRγδ+) intraepithelial lymphocyte (IEL) count increases the likelihood of CD d…”
BackgroundThe Knowledge About Celiac Disease Among Healthcare Professionals and Patients in Central Europe
Rižnik, P., Leo, L. D., Dolinšek, J., Gyimesi, J., Klemenak, M., Koletzko, B. V., Koletzko, S., Koltai, T., Korponay-Szabo, I. R., Krenčnik, T., et al. (2020) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000003019 · Cited by 31 · see citing works
“Recently, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and European Society for the Study of Celiac Disease (ESsCD) published new guidelines for the diagnosis of CD in children and adults, respectively (1,12).”
BackgroundWessels, M., Dolinsek, J., Castillejo, G., Donat, E., Riznik, P., Roca, M., Valitutti, F., Veenvliet, A., & Mearin, M. L. (2022) · European Journal of Pediatrics · doi:10.1007/s00431-021-04318-2 · Cited by 31 · see citing works
“The pattern of follow-up visits was quite similar among the physicians and mostly in line with existing publications regarding the first follow-up visit scheduled 3–6 months after diagnosis, followed, in case of stability, by annual visits [27, 28].”
ResultSelf-citationBrown, I., Bettington, M. L., & Rosty, C. (2020) · Histopathology · doi:10.1111/his.14262 · Cited by 32 · see citing works
“disease, congestive heart failure, hypergammaglobulinaemia, some lymphomas, and enteric infections.(76,77) Although it is not widely used, gluten challenge can be diagnostically useful by inducing villous atrophy and positive serology.”
BackgroundCompliance with Gluten Free Diet Is Associated with Better Quality of Life in Celiac Disease
Enaud, R., Tétard, C., Dupuis, R., Laharie, D., Lamireau, T., Zerbib, F., Rivière, P., Shili‐Masmoudi, S., & Poullenot, F. (2022) · Nutrients · doi:10.3390/nu14061210 · Cited by 31 · see citing works
stefanolo, J. P., Segura, V., Grizzuti, M., Heredia, A., Comino, I., Costa, A. F., Puebla, R. A., Temprano, M. P., Niveloni, S. I., de Diego, G. A., et al. (2024) · World Journal of Gastroenterology · doi:10.3748/wjg.v30.i11.1545 · Cited by 29 · see citing works
Updates in the diagnosis and management of coeliac disease
Shiha, M. G., Zammit, S. C., Elli, L., Sanders, D. S., & Sidhu, R. (2023) · Best Practice & Research Clinical Gastroenterology · doi:10.1016/j.bpg.2023.101843 · Cited by 34 · see citing works
Self-citationKurppa, K., Mulder, C. J. J., Størdal, K., & Kaukinen, K. (2024) · Gastroenterology · doi:10.1053/j.gastro.2023.12.026 · Cited by 30 · see citing works
Self-citationElli, L., Barisani, D., Vaira, V., Bardella, M. T., Topa, M., Vecchi, M. L., Doneda, L., Scricciolo, A., Lombardo, V., & Roncoroni, L. (2020) · BMC Gastroenterology · doi:10.1186/s12876-020-01524-4 · Cited by 27 · see citing works
Calado, J., & Machado, M. V. (2021) · GE Portuguese Journal of Gastroenterology · doi:10.1159/000514716 · Cited by 38 · see citing works
High disease burden in treated celiac patients – a web-based survey
van Megen, F., Skodje, G. I., Stendahl, M., Veierød, M. B., Lundin, K. E. A., & Henriksen, C. (2021) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2021.1930146 · Cited by 29 · see citing works
“ology verified in childhood/adolescence [22].”
Self-citationNew Insights into Non-Dietary Treatment in Celiac Disease: Emerging Therapeutic Options
Segura, V., Ruiz‐Carnicer, Á., Sousa, C., & Moreno, M. D. L. (2021) · Nutrients · doi:10.3390/nu13072146 · Cited by 29 · see citing works
Nutrient deficiencies in children with celiac disease during long term follow-up
Kreutz, J. M., Heynen, L., & Vreugdenhil, A. C. E. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.05.003 · Cited by 29 · see citing works
Nutritional Status and Metabolism in Celiac Disease: Narrative Review
Mędza, A., & Szlagatys‐Sidorkiewicz, A. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12155107 · Cited by 31 · see citing works
Clinical outcomes of potential coeliac disease: a systematic review and meta-analysis
Shiha, M. G., Schiepatti, A., Maimaris, S., Nandi, N., Penny, H. A., & Sanders, D. S. (2024) · Gut · doi:10.1136/gutjnl-2024-333110 · Cited by 29 · see citing works
Self-citationNon-Celiac Gluten/Wheat Sensitivity—State of the Art: A Five-Year Narrative Review
Manza, F., Lungaro, L., Costanzini, A., Caputo, F., Carroccio, A., Mansueto, P., Seidita, A., Raju, S. A., Volta, U., GIORGIO, R. D., et al. (2025) · Nutrients · doi:10.3390/nu17020220 · Cited by 29 · see citing works
Self-citationChen, Y., Li, Y., Deng, J., et al. (2020) · Analytical and Bioanalytical Chemistry · doi:10.1007/s00216-020-02977-y · Cited by 27 · see citing works
“time-consuming, space-occupying and laborious, and usually takes several days to even more than 1 week to obtain detectable strains [13], since the antibodies can barely be detected in serum during the incubation period [14].”
Background
- Authors
- Al-Toma, A., Volta, U., Auricchio, R., Castillejo, G., Sanders, D. S., Cellier, C., Mulder, C. J., & Lundin, K. E. A.
- Affiliations
- St. Antonius Ziekenhuis (NL)
- University of Bologna (IT)
- University of Naples Federico II (IT)
- Institut de Recerca Biomèdica Catalunya Sud (ES)
- Royal Hallamshire Hospital (GB)
- Hôpital Européen Georges-Pompidou (FR)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Oslo University Hospital (NO)
- Corresponding author
- Al-Toma, Abdulbaqi
- ORCID
- Venue
- United European Gastroenterology Journal
- Publisher
- Wiley
- Published
- 2019-06
- Volume
- 7
- Issue
- 5
- Pages
- 583-613
- ISSN
- 2050-6406 (ISSN-L)
- 2050-6414
- PMC
- PMC6545713
- OpenAlex
- W2937921992
- Cited by
- 1,012
- References
- 0
- Citations by year
- 2026: 93 · 2025: 162 · 2024: 177 · 2023: 167 · 2022: 143 · 2021: 157 · 2020: 92 · 2019: 17 · 2018: 2 · 2017: 1
- FWCI
- 93.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- United European Gastroenterology Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (acceptedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
- Health Sciences › Medicine › Surgery › Eosinophilic Esophagitis
- Life Sciences › Agricultural and Biological Sciences › Plant Science › Wheat and Barley Genetics and Pathology
- Keywords
- celiac disease, gluten-related disorders, gluten-free diet, serological testing, duodenal biopsy, refractory celiac disease, dermatitis herpetiformis, non-celiac gluten sensitivity, ataxia, dietary adherence, undiagnosed celiac disease, prevalence
- MeSH terms
- Adult, Celiac Disease, Child, Dermatitis Herpetiformis, Humans, Immunotherapy, Quality of Life, Dietary Supplements, Diet, Gluten-Free
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