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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]
In the citing paper
“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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Items 301–400 of 995
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“HLA-DQ genotyping relies on its high negative predictive value in clinical practice to exclude the possibility of CD [4,30].”
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“Coeliac disease (CD) is an immune-mediated enteropathy triggered by gluten ingestion in genetically susceptible subjects [1].”
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“EoG may be induced by food allergens [11], and GSE is induced by dietary wheat gliadin and related proteins [26].”
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“Immunoglobulin A (IgA) antibody levels should be measured simultaneously because 2–3% of patients with CD suffer from selective IgA de ciency [1].”
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Self-citationCeliac Disease and Gluten-Free Diets: A Path or Barrier to Food (In)Security?
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“Furthermore, 2.7% of patients with autoimmune thy-roiditis were reported to be affected by CD [33], and, as a matter of fact, guidelines suggest testing for CD serology in patients with autoimmune thyroiditis [34].”
InfluentialSchiepatti, A., Maimaris, S., Randazzo, S., Maniero, D., Biti, R., Caio, G., Lungaro, L., Carroccio, A., Seidita, A., Scalvini, D., et al. (2024) · Nutrients · doi:10.3390/nu16162595 · Cited by 10
Impact of a Gluten-Free Diet in Adults With Celiac Disease: Nutritional Deficiencies and Challenges
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“[33], TTGA titres in ICIs-CD are reported to be very high with a range from 104 to >300 IU/mL, so this swept aside any suspicion of a false positive TTGA result which is confined to very low antibody titres [67].”
BackgroundSelf-citationLate Onset of ANCA Vasculitis as a Side Effect of Levamisole Treatment in Nephrotic Syndrome
Bernardi, S., Innocenti, S., Charbit, M., et al. (2022) · Medicina · doi:10.3390/medicina58050650 · Cited by 7
“A duodenal biopsy was then performed, confirming suspicions of celiac disease [11].”
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“Generally, patients diagnosed with CD present with several signs and symptoms, such as anemia, diarrhea, abdominal pain and bloating, osteomalacia, and osteoporosis, among others [2].”
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Rouvroye, M. D., Bontkes, H. J., Bol, J. G. J. M., Lissenberg-Witte, B. I., Byrnes, V., Bennani, F., Jordanova, E. S., Wilhelmus, M. M. M., Mulder, C. J. J., van der Valk, P., et al. (2023) · Acta Neuropathologica Communications · doi:10.1186/s40478-023-01538-5 · Cited by 7
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“Sixth, follow a strict gluten-free diet when T1DM is complicated with celiac disease (60).”
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“This observation supports the role of autoimmunity in PA [18] (in patients suffering from CD majority is HLA-DQ2 and/or DQ8 positive [35, 37, 44]).”
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“Most guidelines recommend regular follow-up with both “physician and dietitian” for patients diagnosed with CeD [13, 17, 18, 20].”
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“Finally, the literature describes that 7–30% of CeD patients are defined as slow responders, since they continue to have symptoms or signs of CeD or laboratory abnormalities after at least 6–12 months of a GFD [72].”
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Cannas, M., Fadda, C., Urgeghe, P. P., Piga, A., & Conte, P. (2024) · Foods · doi:10.3390/foods13182973 · Cited by 6
“The most prevalent of these is celiac disease [3].”
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Vafadar, A., Vosough, P., Alashti, S. K., Taghizadeh, S., & Savardashtaki, A. (2024) · Clinica Chimica Acta · doi:10.1016/j.cca.2024.120092 · Cited by 6
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RetractedNon-coding RNAs in celiac disease
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Self-citationNon-coeliac gluten sensitivity in children
Devulapalli, C. S. (2020) · Tidsskrift for Den norske legeforening · doi:10.4045/tidsskr.19.0777 · Cited by 6
“European Society for the Study of Coeliac Diseases retningslinjer anbefaler fullstendig utredning, inkludert duodenalbiopsi, for å utelukke cøliaki og hveteallergi mens pasienten er på glutenholdig diett (8).”
BackgroundGün, R. D., Kaplan, A. T., Kaymak, N. Z., et al. (2021) · Photodiagnosis and Photodynamic Therapy · doi:10.1016/j.pdpdt.2021.102214 · Cited by 6
Myocarditis in a Young Patient with Celiac Disease; A Case Report and Literature Review
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Sailing the ship of life: scurvy and autoimmunity . . .
Essien, F. A., Jacocks, C., & Carroll, M. (2022) · Therapeutic Advances in Chronic Disease · doi:10.1177/20406223221078080 · Cited by 6
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Celiac disease screening in patients with cryptogenic cirrhosis
Narciso-Schiavon, J. L., & Schiavon, L. D. L. (2023) · World Journal of Gastroenterology · doi:10.3748/wjg.v29.i2.410 · Cited by 6
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“The only effective treatment is a gluten-free diet (GFD), which must be maintained long-life in order to obtain clinical, biochemical and histological recovery but also to prevent the main diseasespecific complications, such as refractory CD, small bowel adenocarcinoma and enteropathy associated T-cell lymphoma (EATL)…”
BackgroundA Look Into the Future: Are We Ready for an Approved Therapy in Celiac Disease?
Anderson, R. P., Verma, R., & Schümann, M. (2024) · Gastroenterology · doi:10.1053/j.gastro.2024.02.005 · Cited by 7
Mean platelet volume can indicate dietary adherence and disease severity of Celiac disease
Gerçeker, E. (2021) · Northern Clinics of Istanbul · doi:10.14744/nci.2021.56313 · Cited by 6
“Cases with symptoms of CD, positive antibodies to gliadin and/or endomysium, typical findings of CD on endoscopic evaluation and positive histopathological findings of CD according to the modified Marsh classification in duodenal mucosal biopsies were considered to be active celiac patients [1, 3].”
BackgroundMethodInfluentialDore, M. P., Errigo, A., Bibbò, S., Manca, A., & Pes, G. M. (2022) · Nutrients · doi:10.3390/nu14091815 · Cited by 6
Ulnes, M., Albrektsson, H., Størdal, K., Saalman, R., Ludvigsson, J. F., & Mårild, K. (2022) · Acta Paediatrica · doi:10.1111/apa.16633 · Cited by 5
Oliveira, L. C., Dornelles, A. C., Nisihara, R., Bruginski, E., dos Santos, P. I., Cipolla, G. A., Boschmann, S. E., Messias-Reason, I., Campos, F. R., Petzl‐Erler, M. L., et al. (2023) · Genes · doi:10.3390/genes14051026 · Cited by 7
Minimal Lesions of the Small Intestinal Mucosa: More than Morphology
Volta, U., Caio, G., Ghirardi, C., Lungaro, L., Mansueto, P., Carroccio, A., & GIORGIO, R. D. (2020) · Digestive Diseases and Sciences · doi:10.1007/s10620-020-06571-1 · Cited by 6
Self-citationSierra, M., Hernanz, N., & Alonso, I. G. Y. L. (2020) · Medicine - Programa de Formación Médica Continuada Acreditado · doi:10.1016/j.med.2020.01.002 · Cited by 6
Fowler, A., FitzPatrick, M. E. B., Shanmugarasa, A., Ibrahim, A. S. F., Kockelbergh, H., Yang, H.-C., Williams-Walker, A. B., Hoang, K. N. L., Evans, S. C., Provine, N. M., et al. (2023) · Biomolecules · doi:10.3390/biom13121707 · Cited by 5
Marcos-Zambrano, L. J., Lacruz-Pleguezuelos, B., Aguilar-Aguilar, E., Marcos-Pasero, H., Valdés, A., Loria‐Kohen, V., Cifuentes, A., de Molina, A. R., Díaz‐Ruiz, A., Pancaldi, V., et al. (2025) · mSystems · doi:10.1128/msystems.00143-25 · Cited by 7
Outcomes in Adults with Celiac Disease Following a Gluten-Free Diet
Balaban, D. V., Enache, I., Balaban, M., David, R. A., Vasile, A.-D., Popp, A., & Jinga, M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14145144 · Cited by 7
“Currently, there is a lack of consensus with regard to the requirement of a repeat biopsy for adults, but it should be considered, especially in older adults and those with severe mucosal injury at diagnosis and seronegative CD [2].”
InfluentialType 1 Diabetes and Other Autoimmune Diseases—Epidemiology, Pathophysiology and Screening
Kahaly, G. J., Forst, T. M., Kellerer, M., Lanzinger, S., Rötzer, R. D., Schott, M., & Schumm‐Draeger, P. (2025) · Endocrinology Diabetes & Metabolism · doi:10.1002/edm2.70119 · Cited by 7
“…g l u c o s e ( F P G ) [ 132 ] G l y c a t e d h a e m o g l o b i n ( H b A 1 c ) O r a l g l u c o s e t o l e r a n c e t e s t ( O G TT ) C o n t i n u o u s g l u c o s e m o n i t o r i n g ( C G M ) [ 133 ] I s l e t c e ll s ( I C ) autoimmune conditions, in particular AITD and T1D [146].”
Xiao, B., Zhang, C., Zhou, J., Wang, S., Meng, H., Wu, M., Zheng, Y., & Yu, R. (2023) · International Journal of Biological Macromolecules · doi:10.1016/j.ijbiomac.2023.125933 · Cited by 5
Celiac Disease: Promising Biomarkers for Follow-Up
Hrunka, M., Janda, Ľ., Šťastná, M., Pinkasová, T., Pecl, J., Kunovský, L., Dítě, P., & Jabandžiev, P. (2023) · Journal of Gastrointestinal and Liver Diseases · doi:10.15403/jgld-4926 · Cited by 5
Erem, F. (2024) · Food Science and Technology International · doi:10.1177/10820132241248486 · Cited by 5
“Adopting a gluten-free diet is the only known way for people suffering from the mentioned disorders to protect themselves from the adverse health effects of gluten (Al-Toma et al., 2019; Sabença et al., 2021).”
Role of endoscopy in the diagnosis of coeliac disease: a narrative review
Shiha, M. G., Yusuf, A., & Sanders, D. S. (2024) · Translational Gastroenterology and Hepatology · doi:10.21037/tgh-23-122 · Cited by 6
“Therefore, CE is not recommended for the diagnosis of CD (30).”
BackgroundSelf-citationFarrier, C. E., Wanat, M., Harnden, A., Paterson, A., Roberts, N. W., Saatci, D., & Hirst, J. A. (2024) · PLoS ONE · doi:10.1371/journal.pone.0306844 · Cited by 6
Schiepatti, A., Maimaris, S., Scalvini, D., Raju, S. A., Ingham, K. E., Johnson, C. M., Rubio‐Tapia, A., Maruggi, C., Malamut, G., Lenti, M. V., et al. (2025) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000003331 · Cited by 5
“5.”
Self-citationThe follow-up of patients with celiac disease
Tola, M. D., Bontkes, H. J., Irure‐Ventura, J., López‐Hoyos, M., & Bizzaro, N. (2025) · Journal of Translational Autoimmunity · doi:10.1016/j.jtauto.2025.100278 · Cited by 6
“On the other hand, all guidelines recommend to re-biopsy in case of persisting or relapsing symptoms after GFD, although the time frame is not clearly stated [22,23,66,67].”
Villar-Balboa, I., Bosque, M. R., Almeda, J., Cunillera, O., Matos, Y. R., Valencia-Pedraza, I., Merino-Audí, M., Arapovic-Amat, I., Sánchez-Gómez, N., Fernández-Gómez, A., et al. (2025) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2025.04.010 · Cited by 7
Trott, N., Holland, W. L., Hoffmann, O., Shiha, M. G., Raju, S. A., Penny, H. A., Whelan, K., & Sanders, D. S. (2025) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.70051 · Cited by 5
Self-citation
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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