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

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CME Questions

ACG Guideline: Diagnosis and Management of Celiac Disease

Chaudrey, Khadija H. MD

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


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.


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)


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


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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