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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, 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]
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“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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“Page 2 of 18 Introduction Celiac disease (CD) is a chronic inflammatory autoimmune disorder characterized by villous atrophy of the small bowel.1 The exposure to dietary wheat gluten and proteins of rye and barley triggers CD among genetically predisposed persons.2 In certain circumstances, individuals show no symptom…”
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Epilepsy, Immunity and Neuropsychiatric Disorders
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“Immunosuppression therapy could only be used in patients where a strict gluten-free diet alone has not been beneficial [204].”
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“5 homozygous individuals (Al-Toma et al., 2019; Bajor et al., 2019a; De Silvestri et al., 2018; Lázár-Molnár & Snyder et al., 2018; Liu et al., 2014).”
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“Gluten ataxia (GA), which is part of the cerebellum ataxia’s group of diseases (CA), may be one of the most-recognized neurological manifestations of CD [34].”
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“that needs to be followed long-term [1].”
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Non-invasive prediction of persistent villous atrophy in celiac disease
Packová, B., Kovalčíková, P., Pavlovský, Z., Bartušek, D., Prokešová, J., & Kroupa, J. D. A. R. (2020) · World Journal of Gastroenterology · doi:10.3748/wjg.v26.i26.3780 · Cited by 10
Güngör, Ş., & Köylü, A. A. (2020) · Cureus · doi:10.7759/cureus.11134 · Cited by 10
Grinevich, V. B., Kravchuk, Y. A., Ped, V. I., Sas, E. I., Salikova, S. P., Владимировна, Г. И., Ei, T., Sitkin, S. I., Лазебник, Л. Б., Голованова, Е. В., et al. (2021) · Экспериментальная и клиническая гастроэнтерология · doi:10.31146/1682-8658-ecg-187-3-5-82 · Cited by 12
Pancreatic involvement in celiac disease
Balaban, D. V., Enache, I., Ciochina, M., Popp, A., & Jinga, M. (2022) · World Journal of Gastroenterology · doi:10.3748/wjg.v28.i24.2680 · Cited by 10
de Oliveira, P. M., Zandonadi, R. P., Cutrim, A. M. V., Nakano, E. Y., de Queiroz, F. L. N., Botelho, R. B. A., Saraiva, A., & Raposo, A. (2022) · Nutrients · doi:10.3390/nu14142815 · Cited by 10
UegWeek 2020 Poster Presentations
de Pierola, L. B. F., Nyssen, O. P., Cosme, Á., Bordin, D. S., Tepeš, B., Aísa, Á. P., Vaira, D., Álvarez, M. C., Fernández, M. C., Lerang, F., et al. (2020) · United European Gastroenterology Journal · doi:10.1177/2050640620927345 · Cited by 10
Kori, M., Zamir, Y., Yermiyahu, S. O., Ainbinder, I., Daichman, S., Pinto, G. D., Weisband, Y. L., Greenfeld, S., Kariv, R., Lederman, N., et al. (2022) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjac176 · Cited by 9
The Role of Diet in Children with Psoriasis: Emerging Evidence and Current Issues
SIMONI, E. D., Rizzetto, G., Molinelli, E., Capodaglio, I., Offidani, A., & Simonetti, O. (2023) · Nutrients · doi:10.3390/nu15071705 · Cited by 9
Silvester, J. A., Elli, L., Khosla, C., & Tye–Din, J. A. (2024) · Gastroenterology · doi:10.1053/j.gastro.2024.01.053 · Cited by 10
School Experiences in the Disease Management of Children With Celiac Disease: A Qualitative Study
Şahin, Ö. Ö., Taşdelen, Y., Kutahyalioglu, N. S., Güney, E. U., & Ozer, K. (2024) · Child Care Health and Development · doi:10.1111/cch.70010 · Cited by 10
FODMAP Diet in Celiac Disease and Gluten-Related Disorders
Usai–Satta, P., Mocci, G., & Lai, M. (2024) · Nutrients · doi:10.3390/nu16234190 · Cited by 12
“Celiac disease (CD) is a chronic, gluten-dependent disease characterized by small bowel mucosal inflammation and injury and consequent malabsorption in genetically predisposed subjects [1–3].”
IFN-γ is a direct driver of crypt hyperplasia in celiac disease
Stamnæs, J., Stray, D., du Pré, M. F., et al. (2025) · Journal of Clinical Investigation · doi:10.1172/jci194858 · Cited by 9
“Marsh grades 2 and 3 both show the presence of crypt hyperplasia, whereas Marsh 3a-c grades in addition have increasing degrees of villous blunting and are considered diagnostic for CeD (21).”
Self-citationHo, S. S. C., Hall, S. W., Keenan, J. I., & Day, A. S. (2021) · Digestive Diseases and Sciences · doi:10.1007/s10620-021-06988-2 · Cited by 9
Modern understanding of adult celiac disease
Oreshko, L. S., Бакулин, И. Г., Avalueva, E. B., et al. (2021) · Экспериментальная и клиническая гастроэнтерология · doi:10.31146/1682-8658-ecg-188-4-84-95 · Cited by 9
Injection of prototypic celiac anti-transglutaminase 2 antibodies in mice does not cause enteropathy
Lindstad, C. B., du Pré, M. F., Stamnæs, J., & Sollid, L. M. (2022) · PLoS ONE · doi:10.1371/journal.pone.0266543 · Cited by 9
“Anti-TG2 IgA and IgG are sensitive and specific markers of the disease [3,4].”
BackgroundVaccination Status and Attitudes towards Vaccines in a Cohort of Patients with Celiac Disease
Costantino, A., Michelon, M., Roncoroni, L., Doneda, L., Lombardo, V., Costantino, C., Vecchi, M. L., & Elli, L. (2022) · Vaccines · doi:10.3390/vaccines10081199 · Cited by 9
“However, the ESsCD states that it is not clear whether vaccination with the conjugated vaccine is preferable in this setting and whether additional vaccination against Haemophilus, meningococcus, and influenza should be considered if not previously given [12].”
BackgroundInfluentialImmune responses to SARS-CoV-2 vaccines in celiac disease
Ibsen, J. H., Chopra, A., Vaage, E. B., et al. (2022) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2022.2114809 · Cited by 9
“Eligible patients were over the age of 18years and diagnosed with CeD by intestinal biopsy [27].”
BackgroundSelf-citationMusculoskeletal Complications of Celiac Disease: A Case-Based Review
Evangelatos, G., Kouna, K., Iliopoulos, A., et al. (2023) · Mediterranean Journal of Rheumatology · doi:10.31138/mjr.34.1.86 · Cited by 9
Old and New Adjunctive Therapies in Celiac Disease and Refractory Celiac Disease: A Review
Valvano, M., Fabiani, S., Monaco, S., Calabrò, M., Mancusi, A., Frassino, S., Rolandi, C., Mosca, M., Faenza, S., Sgamma, E., et al. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms241612800 · Cited by 9
Effectiveness of Anthocyanin-Rich Sour Cherry Extract on Gliadin-Induced Caco-2 Barrier Damage
Klusóczki, Á., Oláh, B., Hosszú, D., Fenyvesi, F., Remenyik, J., Homoki, J. R., Gyöngyösi, A., Bácskay, I., & Váradi, J. (2023) · Nutrients · doi:10.3390/nu15184022 · Cited by 9
de Koning, W., Botero, J., Harnett, J., Cunich, M. M., Okati, L., McNamara, A., Buddrick, O., & Vriesekoop, F. (2024) · Journal of the Royal Society of New Zealand · doi:10.1080/03036758.2024.2387137 · Cited by 10
“Lifeline long adherence to a gluten-free diet (GFD) is indicated in the treatment of coeliac disease, dermatitis herpetiformis and gluten ataxia (Al-Toma et al. 2019).”
Sagu, S. T., Wiedemann, L. T., Nichani, K., et al. (2024) · Separations · doi:10.3390/separations11090271 · Cited by 9
Metadata
- 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
- 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 › 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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