Cited by 1,012Celiac Disease Research and ManagementEosinophilic EsophagitisWheat and Barley Genetics and Pathology

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European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders

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Al-Toma, Abdulbaqi, Volta, Umberto, Auricchio, Renata, Castillejo, Gemma, Sanders, David S, Cellier, Christophe, Mulder, Chris J, Lundin, Knut E A·2019·United European Gastroenterology Journal

DOI 10.1177/2050640619844125PMC PMC6545713

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Abstract

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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Background
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Background
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MethodSelf-citation
Small bowel capsule endoscopy in refractory celiac disease: A luxury or a necessity?
Zammit, S. C. (2021) · Annals of Gastroenterology · doi:10.20524/aog.2021.0586 · Cited by 19
“However, the follow-up interval in these patients and how it should differ between subtypes of RCD remains unclear [3,7,11-13].”
Background
The accuracy of diagnostic indicators for coeliac disease: A systematic review and meta-analysis
Elwenspoek, M. M. C., Jackson, J., O’Donnell, R., Sinobas, A. D., Dawson, S., Everitt, H., Gillett, P. M., Hay, A. D., Lane, D., Mallett, S., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0258501 · Cited by 20
“Abbreviations: BSG: Guidelines from the British Society of Gastroenterology [9]; NICE: National Institute for Health and Care Excellence; ESsCD: European Society for the Study of Coeliac Disease guideline [8]; ESPGHAN: European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines [7].”
Background
Management of psychiatric disorders in patients with hepatic and gastrointestinal diseases
Menon, V., Ransing, R., & Praharaj, S. K. (2022) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry.indianjpsychiatry_18_22 · Cited by 19
“[74] There is evidence to suggest that drug absorption may be increased (e.g. propranolol), delayed, reduced, or normal in CeD; this includes psychotropic medications too.”
Non-coeliac gluten sensitivity
Biesiekierski, J. R., Jonkers, D. M. A. E., Ciacci, C., & Aziz, I. (2025) · The Lancet · doi:10.1016/s0140-6736(25)01533-8 · Cited by 25
A New Intraepithelial γδ T-Lymphocyte Marker for Celiac Disease Classification in Formalin-Fixed Paraffin-Embedded (FFPE) Duodenal Biopsies
Popp, A., Taavela, J., Graziano, P., Parente, P., Covelli, C., Lamacchia, C., Andriulli, A., Mäki, M., & Isola, J. J. (2020) · Digestive Diseases and Sciences · doi:10.1007/s10620-020-06680-x · Cited by 19
Changes in Diet and Anthropometric Parameters in Children and Adolescents with Celiac Disease—One Year of Follow-Up
Kozioł-Kozakowska, A., Salamon, D., Grzenda‐Adamek, Z., Krawczyk, A., Duplaga, M., Gosiewski, T., & Kowalska‐Duplaga, K. (2021) · Nutrients · doi:10.3390/nu13124306 · Cited by 18
Successful novel use of tofacitinib for type II refractory coeliac disease
Grewal, J., Kassardjian, A., & Weiss, G. A. (2022) · BMJ Case Reports · doi:10.1136/bcr-2021-244692 · Cited by 18
Diagnostic management of patients reporting symptoms after wheat ingestion
Costantino, A., Aversano, M. G., Lasagni, G., Smania, V., Doneda, L., Vecchi, M. L., Roncoroni, L., Pastorello, E. A., & Elli, L. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.1007007 · Cited by 19
“The tTG-IgA and endomysial (EMA)-IgA antibody tests have similar sensitivity and both tests have high specificity (19).”
BackgroundInfluential
Characteristics of gut microbiota and fecal metabolomes in patients with celiac disease in Northwest China
Shi, T., Feng, Y., Liu, W., Liu, H., Li, T., Wang, M., Li, Z., Lu, J., Abudurexiti, A., Maimaitireyimu, A., et al. (2022) · Frontiers in Microbiology · doi:10.3389/fmicb.2022.1020977 · Cited by 21
The role of gluten challenge in the diagnosis of celiac disease: a review
Popp, A., Laurikka, P., Czika, D., & Kurppa, K. (2023) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2023.2219893 · Cited by 18
“In the adult CeD guidelines, the commonly recommended procedure for diagnostic GC is to provide at least 6–10 g gluten/day for 1–3 months before the determination of CeD serology [9,26], even though evidence supporting”
BackgroundMethod
Expression of transglutaminase 2 in human gut epithelial cells: Implications for coeliac disease
Amundsen, S. F., Stamnæs, J., Lundin, K. E. A., & Sollid, L. M. (2023) · PLoS ONE · doi:10.1371/journal.pone.0287662 · Cited by 21
Self-citation
Formulation of A Gluten-Free Carob-Based Bakery Product: Evaluation of Glycemic Index, Antioxidant Activity, Rheological Properties, and Sensory Features
Restuccia, D., Esposito, L., Spizzirri, U. G., Martuscelli, M., Caputo, P., Rossi, C. O., Clodoveo, M. L., Pujia, R., Mazza, E., Pujia, A., et al. (2023) · Fermentation · doi:10.3390/fermentation9080748 · Cited by 18
Osteoporosis and bone fractures in patients with celiac disease: A nationwide cohort study
Hansen, S., Schwarz, P., Rumessen, J. J., Linneberg, A. R., & Kårhus, L. L. (2023) · Bone · doi:10.1016/j.bone.2023.116913 · Cited by 19
Trends in the prevalence rates and predictive factors of coeliac disease: A long‐term nationwide follow‐up study
Taavela, J., Kurppa, K., Jääskeläinen, T., Kaartinen, N. E., Rissanen, H. A., Huhtala, H., Mäki, M., & Kaukinen, K. (2023) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17803 · Cited by 18
“43,45,46 Further complicating the situation, most cases with low positive TGA converted to seronegative while reporting consuming gluten.”
Background
Risk of Gluten Cross-Contamination Due to Food Handling Practices: A Mini-Review
Damasceno, R. P. B., Zandonadi, R. P., Mendes, M. M., Cunha, L. C., Raposo, A., Teixeira‐Lemos, E., Chaves, C., & Farage, P. (2024) · Nutrients · doi:10.3390/nu16081198 · Cited by 24
Use of small-bowel capsule endoscopy in cases of equivocal celiac disease
Zammit, S. C., Schiepatti, A., Aziz, I., et al. (2020) · Gastrointestinal Endoscopy · doi:10.1016/j.gie.2019.12.044 · Cited by 18
“Similar to SNVA, milder changes on duodenal histology of raised intraepithelial lymphocytes (IELs) and/or crypt hyperplasia can occur secondary to immune-mediated conditions, medications, and infections (8, 9).”
ResultSelf-citation
Low prevalence of upper endoscopic gastrointestinal findings despite high frequency of alarm symptoms at the time of diagnosis in adult coeliac disease
Maimaris, S., Schiepatti, A., Gabrielli, G. M., et al. (2020) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000001829 · Cited by 18
Self-citation
New developments in celiac disease treatments
Buriánek, F., Gege, C., & Marinković, P. (2024) · Drug Discovery Today · doi:10.1016/j.drudis.2024.104113 · Cited by 18
Malignancies in Patients with Celiac Disease: Diagnostic Challenges and Molecular Advances
Ivanova, M. D., Bottiglieri, L., Sajjadi, E., Venetis, K., & Fusco, N. (2023) · Genes · doi:10.3390/genes14020376 · Cited by 17
Nutritional assessment of women with celiac disease compared to the general population
van Megen, F., Fossli, M., Skodje, G. I., Carlsen, M. H., Andersen, L. F., Veierød, M. B., Lundin, K. E. A., & Henriksen, C. (2023) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2023.01.031 · Cited by 16
Self-citation
Multicenter study to compare the diagnostic performance of CLIA vs. FEIA transglutaminase IgA assays for the diagnosis of celiac disease
Castelijn, D. A. R., Mulder, A. H. L., van der Pol, P., Hollander, J. C., Kuiper, T., Bijnens, C., Damoiseaux, J. G. M. C., & Bontkes, H. J. (2023) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2022-1045 · Cited by 21
Computer-Based Diagnosis of Celiac Disease by Quantitative Processing of Duodenal Endoscopy Images
Molder, A., Balaban, D. V., Molder, C. C., Jinga, M., & Robin, A. (2023) · Diagnostics · doi:10.3390/diagnostics13172780 · Cited by 19
Celiac Disease, Gluten-Free Diet and Metabolic Dysfunction-Associated Steatotic Liver Disease
Cazac, G.-D., Mihai, B. M., Ștefănescu, G., Gîlcă-Blanariu, G.-E., Mihai, C., Grigorescu, E.-D., Onofriescu, A., & Lăcătușu, C.-M. (2024) · Nutrients · doi:10.3390/nu16132008 · Cited by 18
“The primary treatment for CD consists of strict adherence to a permanent gluten-free diet (GFD) [4–6].”
BackgroundResultInfluential
γδ+ T-Cells Is a Useful Biomarker for the Differential Diagnosis between Celiac Disease and Non-Celiac Gluten Sensitivity in Patients under Gluten Free Diet
Martín‐Cardona, A., Carrasco, A., Arau, B., Vidal, J., Tristán, E., Ferrer, C., González-Puglia, G., Pallarés, N., Tebé, C., Farráis, S., et al. (2024) · Nutrients · doi:10.3390/nu16142294 · Cited by 18
“Celiac disease (CD) involves a systemic autoimmune process resulting from a permanent intolerance to gluten and occurs in genetically susceptible individuals [1,2].”
BackgroundMethodInfluential
Celiac Disease Deep Learning Image Classification Using Convolutional Neural Networks
Carreras, J. (2024) · Journal of Imaging · doi:10.3390/jimaging10080200 · Cited by 20
“Persistent or recurring symptoms may be due to a lack of adherence to dietary protocol, an incorrect initial diagnosis, or complications of refractory celiac disease and lymphoma [1].”
BackgroundMethodInfluential
Coeliac disease: complications and comorbidities
Ludvigsson, J. F., Yao, J., Lebwohl, B., Green, P. H. R., Yuan, S., & Leffler, D. A. (2025) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-024-01032-w · Cited by 24
“The European Society for the Study of Celiac Disease and the American College of Gastroenterology recommend screening for coeliac disease in over 25 conditions 3,4 .”
Association between intestinal neoplasms and celiac disease: A review
Wang, M., Yu, M., Kong, W., Cui, M., & Gao, F. (2021) · World Journal of Gastrointestinal Oncology · doi:10.4251/wjgo.v13.i9.1017 · Cited by 20
Increased Prevalence of Celiac Disease in Patients with Cystic Fibrosis: A Systematic Review and Meta-Analysis
Imrei, M., Németh, D. I., Szakács, Z., Hegyi, P., Kiss, S., Alizadeh, H., Dembrovszky, F., Pázmány, P., Bajor, J., & Párniczky, A. (2021) · Journal of Personalized Medicine · doi:10.3390/jpm11090859 · Cited by 18
Effects of a gluten challenge in patients with irritable bowel syndrome: a randomized single-blind controlled clinical trial
Saadati, S., Sadeghi, A., Shalmani, H. M., Rostami‐Nejad, M., Elli, L., Asadzadeh‐Aghdaei, H., Rodrigo, L., & Zali, M. R. (2022) · Scientific Reports · doi:10.1038/s41598-022-09055-6 · Cited by 17
A No-Biopsy Approach for the Diagnosis of Celiac Disease in Adults: Can It Be Real?
Baykan, A. R., Cerrah, S., Çiftel, S., Vural, M. K., & Kasap, E. (2022) · Cureus · doi:10.7759/cureus.26521 · Cited by 17
“Finally, in the guidebook proposed by the European Society for the Study of Coeliac Disease (ESsCD) [20] in 2019, it was stated that the subject is under investigation and more data are needed before a recommendation can be made.”
Method
Refractory celiac disease and COVID-19 outbreak: Findings from a high incidence scenario in Northern Italy
Elli, L., Scaramella, L., Lombardo, V., et al. (2020) · Clinics and Research in Hepatology and Gastroenterology · doi:10.1016/j.clinre.2020.07.026 · Cited by 16
Focused B cell response to recurring gluten motif with implications for epitope spreading in celiac disease
Zhou, C., Østerbye, T., Bach, E., et al. (2022) · Cell Reports · doi:10.1016/j.celrep.2022.111541 · Cited by 16
Self-citation
Deregulation of miRNAs-cMYC circuits is a key event in refractory celiac disease type-2 lymphomagenesis
Vaira, V., Gaudioso, G., Laginestra, M. A., Terrasi, A., Agostinelli, C., Bòsari, S., Sabatino, A. D., Vanoli, A., Paulli, M., Ferrero, S., et al. (2020) · Clinical Science · doi:10.1042/cs20200032 · Cited by 16
Frequency of Gluten-Reactive T Cells in Active Celiac Lesions Estimated by Direct Cell Cloning
Qiao, S., Dahal‐Koirala, S., Eggesbø, L. M., et al. (2021) · Frontiers in Immunology · doi:10.3389/fimmu.2021.646163 · Cited by 16
“Patients received diagnosis based on the guidelines from European Society for the Study of Coeliac Disease (ESsCD) (12).”
MethodSelf-citation
Black Cumin Pressing Waste Material as a Functional Additive for Starch Bread
Różyło, R., Piekut, J., Wójcik, M., et al. (2021) · Materials · doi:10.3390/ma14164560 · Cited by 16
Refractory celiac disease type 2: how to diagnose and treat?
Soldera, J., Salgado, K. R., & Pêgas, K. L. (2021) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.67.02.20200618 · Cited by 16

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: Al-Toma, Abdulbaqi
Volta, Umberto
Auricchio, Renata
Castillejo, Gemma
Sanders, David S
Cellier, Christophe
Mulder, Chris J
Lundin, Knut E A
Venue: United European Gastroenterology Journal
Publisher: Wiley
Published: 2019-06
Volume: 7
Issue: 5
Pages: 583-613
ISSN: 2050-6406 (ISSN-L)
2050-6414
DOI: 10.1177/2050640619844125
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
FWCI: 93.16
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
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 › Gastroenterology › 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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European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders

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