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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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InfluentialIs There a Time and a Place for the Gluten-Free Diet in Potential Celiac Disease?
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Kazyulin, A. N., Goncharenko, A. Y., Евгеньевна, П. Е., Lyubozhnova, I. Y., & Kalyagin, I. E. (2024) · Russian Journal of Evidence-Based Gastroenterology · doi:10.17116/dokgastro20241301166 · Cited by 2
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“…2023 identified 8 records in PubMed, 3 of which were suitable for pediatric patients: European Society Paediatric Gas-troenterology, Hepatology and Nutrition (ESPGHAN) guideline [22], European Society for the Study of Coeliac Disease (ESsCD) [23] and Italian societies of gastroenterology [24].”
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InfluentialGenetic differences between diagnosed and undiagnosed Celiac disease: a population-based study
Alam, M. S., Wolford, B. N., Hveem, K., et al. (2025) · Human Genetics · doi:10.1007/s00439-025-02778-2 · Cited by 2
“The CeD screening followed the ESsCD guidelines detailed here (Al-Toma et al. 2019 ).”
Self-citationSeidita, A., Mansueto, P., Soresi, M., Liberto, D. D., Carlo, G. D., Bisso, G., Cosenza, S., Pistone, M., Giuliano, A., Spagnuolo, G., et al. (2025) · Nutrients · doi:10.3390/nu17193172 · Cited by 2
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Ionescu, V. A., Ciontu, A. E., Ianuș, G. I., Buică, V., Năstac, A., Baban, I.-A., Barbu, A., Tiucă, L.-C., Antonie, N. I., Gheorghe, G., et al. (2025) · Gastrointestinal Disorders · doi:10.3390/gidisord7040079 · Cited by 2
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The Benefits of Non-pharmacological Interventions
Ninot, G. (2020) · Springer eBooks · doi:10.1007/978-3-030-60971-9_4 · Cited by 2
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“is satisfactorily recognised today, but atypical CD forms have been signed under insufficient diagnostics (4).”
BackgroundCeliac Disease, Management, and Follow-Up
Ruiz‐Carnicer, Á., Segura, V., Sousa, C., & Comino, I. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.104652 · Cited by 2
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“2 haplotypes are the most common genotypes in CD.”
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“lous atrophy) in relation to the ingestion of a food antigen: gluten » (2).”
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Kımıloğlu, E., Karagülle, A., Keçeciler, M., Karatay, E., & Koç, D. Ö. (2023) · The Turkish Journal of Gastroenterology · doi:10.5152/tjg.2023.22288 · Cited by 2
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Gluten related disorders: a review of the literature
Kamilova, A. T., Azimova, N. D., & Zakharova, I. N. (2023) · Pediatrics Consilium Medicum · doi:10.26442/26586630.2023.3.202389 · Cited by 2
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“…(tTG) serology and serum total IgA (IgG tTG in case of IgA deficiency) and who underwent upper gastrointestinal endoscopy with multiple biopsy sampling of the duodenal bulb (one to two fragments) and distal duodenum (four fragments), in line with currently available guidelines [3,4].”
MethodResultPereira, E. D. S., Raphaelli, C. D. O., Massaut, K. B., Ribeiro, J. A., Vitola, H. R. S., Pieniz, S., & Fiorentini, Â. M. (2023) · Current Nutrition & Food Science · doi:10.2174/0115734013252358231016181809 · Cited by 2
Silvestri, I., Merigo, G., Bonetti, C., Guerra, M. B., Pignatelli, S., Stirparò, G., & Ristagno, G. (2023) · Acta bio-medica dell'Ateneo parmense/Acta biomedica · doi:10.23750/abm.v94i6.15014 · Cited by 2
“In this scenario, two factors contributed to reduced serum potassium levels: increased excretion due to diarrhea and reduced intake resulting from malabsorption (17, 18).”
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Fernández‐Bañares, F., Crespo, L., Planella, M., Farráis, S., Izquierdo, S., López‐Palacios, N., Roy, G., Vidal, J., & Núñez, C. (2024) · Nutrients · doi:10.3390/nu16020232 · Cited by 2
Nowak, B., Wanat, M., Świątko, A., Mirkowski, K., Tarkowski, V., Mrożek, A., Mazurek, M., Domański, J., & Domagała, Z. (2023) · Medical Journal of Cell Biology · doi:10.2478/acb-2023-0015 · Cited by 2
Baseer, K. A. A., Mohammed, A. E., Elwafa, A. M. A., & Sakhr, H. M. (2024) · BMC Pediatrics · doi:10.1186/s12887-024-04575-8 · Cited by 3
“Antibody testing against gliadin and deamidated gliadin peptide for the diagnosis of celiac disease has been substituted by tTG-IgA antibodies and EMA testing, which both have higher specificity and sensitivity [25].”
MethodPredominantly antibody deficiency and the association with celiac disease in Sweden
DiGiacomo, D. V., Roelstraete, B., Lebwohl, B., et al. (2024) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2024.01.019 · Cited by 2
Chaves, C., Zandonadi, R. P., Raposo, A., Nakano, E. Y., Ramos, F., Farage, P., & Teixeira‐Lemos, E. (2024) · Frontiers in Immunology · doi:10.3389/fimmu.2024.1372369 · Cited by 2
Automated classification of celiac disease in histopathological images: a multi-scale approach
Püttmann, S., Ferrís, L. B., Marini, N., Aswolinskiy, W., Vatrano, S., Fraggetta, F., Nagtegaal, I. D., van der Post, C. R. S., Ciompi, F., Atzori, M., et al. (2024) · SPIE Medical Imaging: Computer-Aided Diagnosis · doi:10.1117/12.3006669 · Cited by 2
“19 At least four biopsies should be taken from the descending duodenal pars, 33 and in doubtful cases (latent or potential celiac disease) also two biopsies from the duodenal bulb.”
BackgroundHerawati, H., Fetriyuna, F., Agustinisari, I., et al. (2024) · Sains Malaysiana · doi:10.17576/jsm-2024-5302-07 · Cited by 2
“Nowadays, there has been a substantial increase in the prevalence of CD over the last 50 years and the number of CD patients is undiagnosed (Al-Toma et al. 2019).”
BackgroundMonitoring coeliac disease in 2024, time to change practice?
Raju, S. A., Shiha, M. G., & Penny, H. A. (2024) · Current Opinion in Gastroenterology · doi:10.1097/mog.0000000000001009 · Cited by 2
“…coeliac disease, of be used to assess for complications associated with coeliac disease in those with persisting symptoms However, it should be noted both guidelines advise against the use of VCE to diagnose coeliac disease unless unable to complete an upper gastrointestinal endoscopy [49,54].”
BackgroundIntolerance of gluten-containing cereals
Leković, Z., Radlović, V., Mladenović, M., Dučić, S., Rosić, P., Djuričić, G., Samardžić, J. P., & Radlović, N. (2024) · Srpski arhiv za celokupno lekarstvo · doi:10.2298/sarh230712054l · Cited by 2
“The importance of DQ2 and DQ8 glycoproteins present on antigen-presenting cells (dendritic cells and macrophages) in the pathogenesis of CD lies in their ability to, after binding with deaminated gluten polypeptide hydrolysates, activate intestinal CD4+ T-cells [7, 10].”
BackgroundInfluentialUncovering the gap: Coeliac disease knowledge among healthcare professionals in the Danube region
Rižnik, P., Čarnohorski, I., Dolinšek, J., et al. (2024) · BMC Gastroenterology · doi:10.1186/s12876-024-03349-x · Cited by 2
Stødle, I. H., Koldsland, O. C., Lukina, P., Andersen, I. L., Mjønes, P., Rønne, E., Høvik, H., Ness‐Jensen, E., & Verket, A. (2024) · International Journal of Dentistry · doi:10.1155/2024/1952244 · Cited by 3
“Diagnosis of celiac disease in adults is based on positive serology of anti-transglutaminase 2 (anti-TG2) antibodies, which are produced as a response to gluten ingestion and histological con fi rmation of intestinal villous atrophy [8].”
BackgroundВИКОРИСТАННЯ ПРОДУКТІВ ПЕРЕРОБКИ НАСІННЯ КОНОПЕЛЬ ДЛЯ ВИГОТОВЛЕННЯ ХЛІБА
Gunko, S., Науменко, О., Гетьман, І. А., Королюк, К. Є., Лук’янчук, І. В., & Кузнєцова, І. В. (2024) · Food Resources · doi:10.31073/foodresources2024-22-06 · Cited by 4
Xiang, J., Zheng, X., Luo, L., & Yang, X. (2024) · Frontiers in Immunology · doi:10.3389/fimmu.2024.1453657 · Cited by 2
Rouvroye, M. D., Roos, A., Bergkamp, F., et al. (2024) · Human Immunology · doi:10.1016/j.humimm.2024.111158 · Cited by 2
Romeo, M., Nardo, F. D., Napolitano, C., et al. (2024) · Digestive and Liver Disease · doi:10.1016/j.dld.2024.11.007 · Cited by 2
Raju, S. A., Ingham, K. E., Green, O., et al. (2024) · Journal of Gastrointestinal and Liver Diseases · doi:10.15403/jgld-5659 · Cited by 2
Self-citationPrasad, G., Kulkarni, K., Dhua, A. K., et al. (2025) · BMJ Case Reports · doi:10.1136/bcr-2024-263684 · Cited by 2
Martín‐Cardona, A., Carrasco, A., Ferrer, C., Mínguez, C. G., Luizaga, L. A., Tarroch, X., González-Puglia, G., Tristán, E., Cardozo-Rembado, N. B., Pallarés, N., et al. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26031349 · Cited by 2
“In fact, the limit of normal lymphocyte infiltration in the duodenum for diagnosis of coeliac disease (CD) [3–6] or the normal value of eosinophils in the oesophagus for oeosinophilic oesophagitis (EoE) [7] was not established until recently.”
Maimaris, S., Mangili, L., Minerba, P., et al. (2025) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000002953 · Cited by 2
“CD was diagnosed based on positive IgA endomysial antibodies (EmA)/tissue transglutaminase antibodies (TTA) and correctly oriented biopsies taken from the second portion of duodenum showing a certain degree of VA while on a gluten-containing diet [1–3].”
Yang, L., Halder, A., Holt, B. A., et al. (2025) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.17013 · Cited by 2
Dota, M., Rubbini, L., Massetti, G., Scarcella, C., Maimaris, S., Bianchi, P. I., Maniero, D., Sabatino, A. D., Biagi, F., Zingone, F., et al. (2025) · Digestive Diseases and Sciences · doi:10.1007/s10620-025-09183-9 · Cited by 4
“For each patient, diagnosis of CD was based on positive endomysial/tissue transglutaminase antibodies and a certain degree of villous atrophy (VA) on biopsies taken from the second duodenal portion, while patients were on a gluten-containing diet, in accordance with international guidelines [1–3].”
Zingone, F., Canova, C., Forss, A., Ebrahimi, F., Cazzagon, N., Rosato, I., & Ludvigsson, J. F. (2025) · Liver International · doi:10.1111/liv.70293 · Cited by 3
Celiac disease - a review on recent advances in characteristics, diagnostic and treatments
Artykiewicz, K., Czarkowski, M., Gorczyca, K., Grodkiewicz, M., Kozieł, P., Krzysiek, U., Podgórska, K., Puła, A., Słupczyńska, A., & Urbaś, W. (2022) · Journal of Education Health and Sport · doi:10.12775/jehs.2023.13.01.001 · Cited by 4
Bone Metabolism in Inflammatory Bowel Disease and Celiac Disease
Valero, C., & García, M. J. (2019) · Clinical Reviews in Bone and Mineral Metabolism · doi:10.1007/s12018-019-09269-9 · Cited by 2
Ben‐Tov, A., Cohen, S., Shamir, R., et al. (2020) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000002624 · Cited by 2
Chronic Diarrhea in Children: Causes, Mechanisms, Primary Diagnostics and Management
Печкуров, Д. В., & Tyazheva, A. A. (2020) · Вопросы современной педиатрии · doi:10.15690/vsp.v18i6.2061 · Cited by 2
“Тем не менее есть общие принципы диетотерапии при синдроме хронической диареи — ограничение продуктов, усиливающих моторику (богатые клетчаткой свежие фрукты и овощи) и способствующих брожению (дрожжевые продукты, бобовые) [36, 44].”
Popa, S., & Chiarioni, G. (2020) · Digestive Medicine Research · doi:10.21037/dmr-20-28 · Cited by 2
“CD is a chronic immune-mediated enteropathy triggered by gluten ingestion in genetically predisposed subjects (1).”
BackgroundInfluentialCOVID-19 and celiac disease – concerns to be addressed
Garrido, I., Peixoto, A., & Macedo, G. (2020) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000001858 · Cited by 2
Al‐Toma, D., van de Meeberg, M. M., & Al-Toma, A. A. (2021) · Journal of Digestive Diseases · doi:10.1111/1751-2980.12987 · Cited by 2
“Over the past 50 years there has been a significant increase in the prevalence of CeD.(3) In Western countries its prevalence is around 0.”
BackgroundMethodInfluentialSelf-citationMiró, M., Alonso-Garrido, M., Lozano, M., Peiró, J., & Manyes, L. (2021) · Heliyon · doi:10.1016/j.heliyon.2021.e06642 · Cited by 2
“Once gluten is removed from the diet, levels of TGA-IgA antibodies should stabilize in the next 6–12 months and damage to the digestive mucosa should be reversed in around 6–24 months [5].”
BackgroundSiddiqui, K., Rafiq, M., Bhutto, M. A., et al. (2021) · Khyber Medical University Journal · doi:10.35845/kmuj.2021.20553 · Cited by 2
A sokarcú gluténérzékenység: gluténindukált autoimmunitás a bőrgyógyász szemével
Malkovics, T., Koszorú, K., Kárpáti, S., Arató, A., Görög, A., & Sárdy, M. (2021) · Orvosi Hetilap · doi:10.1556/650.2021.32046 · Cited by 2
Description of a clinical case of combination of celiac disease and ichthyosis in a girl
Kamilova, A. T., Geller, S. I., & Ubaykhodjaeva, X. T. (2021) · Meditsinskiy sovet = Medical Council · doi:10.21518/2079-701x-2021-11-134-139 · Cited by 2
Al-Toma, A. A. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-821846-4.00008-5 · Cited by 2
Self-citationEpidemiology and burden of gluten-related disorders
Pourhoseingholi, M. A. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-821846-4.00011-5 · Cited by 4
Derahim, N., Hashim, H. S., Ali, N., & Aziz, S. (2017) · Malaysian Journal of Society and Space · Cited by 2
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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