ACG Guideline: Diagnosis and Management of Celiac Disease : Official journal of the American College of Gastroenterology | ACG

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ACG Guideline: Diagnosis and Management of Celiac Disease

Chaudrey, Khadija H. MD

Author Information
The American Journal of Gastroenterology 118(1):p 23, January 2023. | DOI: 10.14309/ajg.0000000000002111

LEARNING OBJECTIVE

After this activity, the participant will be able to understand the diagnostic approach to celiac disease (CD) in patients as well as the monitoring of patients with CD.

QUESTION 1

A 32-year-old woman with autoimmune thyroiditis presents with a 5-year history of intermittent diarrhea and bloating. Her only medication is levothyroxine 50 μg daily. Four months ago, she decided to go on a strict gluten free diet (GFD) and her symptoms improved with resolution of bloating and diarrhea. While on GFD, her immunoglobulin A (IgA) tissue transglutaminase (TTG) antibody test was negative and serum IgA level was normal. She is reluctant to undergo a formal gluten challenge.

Which of the following is the next best step?

  • A. Perform HLA-DQ2/DQ8 genotyping
  • B. Obtain duodenal biopsies
  • C. Get a D-xylose test
  • D. Order immunoglobulin G (IgG)-deamidated gliadin peptides (DGPs)

QUESTION 2

A 19-year-old man with CD presents to the clinic for a follow-up. He was diagnosed with CD 4 months ago and had a complete resolution of diarrhea and bloating after starting a GFD. He recently moved into his college dorm and continues to be on GFD, but has noticed a recurrence of mild diarrhea.

Which of the following should you order next?

  • A. Serology (IgA TTG or IgA [or IgG] DGP antibodies)
  • B. Upper endoscopy with intestinal biopsies
  • C. Dietitian consult
  • D. Stool studies

QUESTION 3

In a patient with selective IgA deficiency who is on a normal diet, what is the recommended initial test for the detection of celiac disease?

  • A. HLA-DQ2/DQ8 testing
  • B. IgG-based testing
  • C. Antibodies directed against native gliadin
  • D. Upper endoscopy with duodenal biopsies

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