Practice Guidelines

ACG Releases Guideline on Diagnosis and Management of Celiac Disease

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Am Fam Physician. 2014 Mar 15;89(6):485-487.

Guideline source: American College of Gastroenterology

Evidence rating system used? Yes

Literature search described? No

Guideline developed by participants without relevant financial ties to industry? No

Published source: American Journal of Gastroenterology, May 2013

Available at:

There has been a substantial increase in the prevalence of celiac disease over the past 50 years, and in the rate of diagnosis over the past decade. Despite this, it remains underdiagnosed in the United States. The American College of Gastroenterology (ACG) has released clinical guidelines with recommendations for diagnosing and managing celiac disease.


Celiac disease is one of the most common causes of chronic malabsorption. Patients with symptoms, signs, or laboratory evidence of malabsorption (e.g., chronic diarrhea with weight loss, steatorrhea, postprandial abdominal pain and bloating) should be tested for celiac disease. Because the prevalence of celiac disease in clinical scenarios varies from modest (e.g., in patients with irritable bowel syndrome) to substantial (e.g., in those with unexplained iron deficiency anemia), patients in whom celiac disease is a treatable cause should also be considered for testing.

The incidence of celiac disease is significantly increased among persons with a first-degree family member who has the disease. Persons with an immediate family member who has a confirmed diagnosis should be tested if they have signs, symptoms, or laboratory evidence of the disease. Testing should be considered for asymptomatic immediate family members of persons with a confirmed diagnosis. Families in which more than one person has been diagnosed with celiac disease are considered high risk, and screening recommendations should extend to all other family members, including second-degree relatives.

Celiac disease should be considered as a potential explanation for elevated serum transaminase levels when no other etiology can be found. Hypertransaminasemia is a potential subclinical finding that is gluten dependent in patients with celiac disease.

There is evidence that celiac disease is significantly more common in persons with type 1 diabetes mellitus than in the general white population, and that it is associated with greater risk of retinopathy and nephropathy. However, testing for celiac disease in asymptomatic patients is controversial. Patients with type 1 diabetes should be tested for celiac disease only if they have digestive symptoms, signs, or laboratory evidence of the disease.

Diagnostic Testing

All diagnostic serologic testing for celiac disease should be performed before a gluten-free diet is initiated. Antibodies directed against

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