AGA InstituteAGA Institute Medical Position Statement on the Diagnosis and Management of Celiac Disease
Section snippets
Pathogenesis
Celiac disease is the result of an interplay that involves the host’s genetic makeup, immunologic factors, and derivatives of gluten from wheat, rye, and barley. Gluten and other proline-rich proteins are poorly digested in the normal human small intestinal tract due to a lack of prolyl endopeptidases. This results in the generation of gluten peptides that can be as large as 10–50 amino acids in length. Gluten is also rich in the amino acid glutamine. Some of the glutamines in the peptides
Epidemiology
The general population prevalence of celiac disease in the United States is approximately 1:100 (1%), with a reasonable range of 1:80 to 1:140 (1.25% to 0.71%). Most cases remain undiagnosed until later in life. Clinicians should have a heightened suspicion that celiac disease may be present at any age in both sexes and in a wide variety of clinical circumstances.
Diagnosis
Diagnostic tests should be performed before the initiation of gluten restriction begins. Positive serologic test results may resolve and histologic findings may improve with the removal of gluten from the diet. The initial detection of possible celiac disease is probably best obtained by the use of a simple and accurate serologic test: the IgA tTGA.
Treatment
Treatment of celiac disease requires a strict, lifelong adherence to a GFD. This is also the case for patients with dermatitis herpetiformis. Clinicians need to ensure that patients have adequate education, motivation, and support to achieve this diet. Consultation with an experienced dietician, referral to a support group, and clinical follow-ups for compliance are recommended. Treatment of nutritional deficiency states (eg, iron, folate, vitamin B12) is essential, and a determination of bone
Nonresponsive Celiac Disease
Patients with known celiac disease can continue to have or can redevelop symptoms despite being on a GFD. These symptoms may be due to incompletely healed celiac disease, an associated condition, a complication, or a second unrelated diagnosis. Persistent or intermittent symptoms due to known or inadvertent ingestion of gluten are commonly reported. If gluten ingestion is not suggested by direct review of the dietary history or positive serologic test result, then a careful search should be
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