celiac disease

Celiac disease is an autoimmune disease that can occur through the lifespan and is characterized by immune-mediated enteropathy in response to dietary gluten.1 Celiac disease affects at least 1% of the global population. Important risk factors are a first-degree relative with celiac disease, carrying specific genetic variants, presence of other autoimmune conditions (eg, type 1 diabetes, Hashimoto thyroiditis), and certain chromosomal disorders (eg, Down syndrome, Turner syndrome, Williams syndrome).

Typical gastrointestinal symptoms include diarrhea (38%), abdominal discomfort (34%), and weight loss from malabsorption (16%).2 Subjective improvement in symptoms with a gluten-free diet has a poor positive predictive value (PPV) for celiac disease (36%), making objective testing essential. Diagnostic guidelines (Table) recommend performing serologic testing in individuals with symptoms and/or signs suggestive of celiac disease while they are consuming a diet containing gluten, which is present in wheat, barley, and rye. Gluten reduction or removal from the diet impairs the diagnostic accuracy of screening.3-7 For patients already following a gluten-free diet, gluten consumption must be resumed prior to screening. However, there is no consensus for the dose or duration of gluten consumption that should be maintained through second confirmatory tests. Of the 2 most recent guidelines, one does not specify a dose or duration4 and one suggests at least 3 g per day for at least 6 weeks.3

Author/s:

MD, Marisa G. Stahl, MSCS, Claire Jansson-Knodel

What Is Celiac Disease?

Mary Cervantes — Mon, 17 Aug 2026 17:21:29 +0000

Date Added:

August 17, 2026

Journal/Publication:

JAMA Patient Page

Publisher:

JAMA

Publication Date:

August 12, 2026

URL:

What Is Celiac Disease?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2026.13079

Keywords

MeSH

Information for patients about celiac disease. James W. Mold, MD, MPH

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Celiac disease is a chronic autoimmune disease caused by consumption of gluten in people with specific genetic markers. Celiac disease affects about 1% of people worldwide and people can start having symptoms at any age. Individuals at increased risk include those with a first-degree relative who has celiac disease and those with autoimmune diseases (eg, type 1 diabetes or Hashimoto thyroiditis) and certain chromosomal conditions (Down syndrome, Turner syndrome, or Williams syndrome).

Author/s:

Kristin L. Walter

Celiac Disease

Megan George — Thu, 09 Apr 2026 22:54:49 +0000

Date Added:

April 9, 2026

Journal/Publication:

New England Journal of Medicine

Publication Date:

April 8, 2026

URL:

Celiac Disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1056/NEJMcp2415548

Keywords

Immunoglobulin A

HLA-DQ8 antigen

celiac disease

PMID (1):

41950475

MeSH

Protein Glutamine gamma Glutamyltransferase 2

A review of the diagnosis and treatment of patients with celiac disease. James W. Mold, MD, MPH

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Celiac disease, a common autoimmune condition affecting approximately 1% of the population, can develop with exposure to gluten at any age. Diagnosis involves serologic testing, especially for IgA antibodies against tissue transglutaminase, and may include tests to confirm the presence of endomysial antibodies or even duodenal biopsies, although the latter are becoming less necessary. The presence of genes encoding HLA-DQ2 or HLA-DQ8 is a prerequisite for the disease. A gluten-free diet is the mainstay of treatment, but some adults have nonresponsive celiac disease, which warrants closer monitoring because of an increased risk of malignant conditions. Celiac disease also frequently co-occurs with other autoimmune disorders, such as type 1 diabetes mellitus and autoimmune thyroid disease.

Author/s:

Joseph A. Murray, Steffen Husby

Diagnosis and management of celiac disease

Megan George — Tue, 11 Nov 2025 14:35:21 +0000

Date Added:

November 11, 2025

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

November 11, 2025

URL:

Diagnosis and management of celiac disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.230091

Keywords

celiac disease

diet

Gluten-Free

MeSH

Protein Glutamine gamma Glutamyltransferase 2

A concise review of the diagnosis and management of patients with celiac disease. James W. Mold, MD, MPH

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Celiac disease is frequently undiagnosed, in part because of its highly variable clinical presentation.

Celiac disease can present with classic gastrointestinal symptoms (e.g., diarrhea, abdominal pain, bloating, weight loss), atypical or extraintestinal manifestations (e.g., anemia, osteoporosis, neurologic symptoms, infertility, fatigue) or asymptomatic presentations detected from screening.

The first-line serologic screening test measures tissue transglutaminase immunoglobulin A and should be conducted while the patient is consuming gluten.

Complications of celiac disease include nutritional deficiencies, osteoporosis, increased risk of viral infections and pneumonia, and, rarely, risk of malignancy.

Adherence to a lifelong, strict gluten-free diet with regular monitoring of disease activity and nutritional status is key for symptom management and to prevent complications.

Author/s:

Jedid-Jah Blom, Dominica Gidrewicz, Justine Turner, Donald R. Duerksen, M. Ines Pinto-Sánchez

Diagnosis and Management of Celiac Disease

Alex Haga — Sun, 30 Jun 2024 18:10:50 +0000

Date Added:

June 30, 2024

Journal/Publication:

JAMA

Publication Date:

June 26, 2024

URL:

Diagnosis and Management of Celiac Disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.5883

Keywords

Gastroenterology

celiac disease

PMID (1):

38922595

MeSH

Protein Glutamine gamma Glutamyltransferase 2

celiac disease

Gastroenterology

Hematologic Tests

American College of Gastroenterology Guideline for the diagnosis and management of celiac disease. James W. Mold, MD, MPH

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Guideline title American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease

Release date January 2023

Prior version May 2013

Developer and funding source American College of Gastroenterology

Target population Children and adults with celiac disease

Selected recommendations

Screening for celiac disease in asymptomatic people in the general population is not recommended (strong recommendation; low quality of evidence).

Upper endoscopy with multiple (≥4) duodenal biopsies is recommended for diagnostic confirmation in both children and adults who have characteristic signs and symptoms of celiac disease (strong recommendation; moderate quality of evidence).

In symptomatic children, a blood test with high-level tissue transglutaminase antibody (tTG) IgA (>10 times the upper limit of normal) and presence of endomysial antibody (EMA) in a second blood sample are suggested for diagnosis of celiac disease. In symptomatic adults who are unwilling or unable to undergo upper endoscopy, high-level tTG IgA and presence of EMA can be used to establish a diagnosis of likely celiac disease (conditional recommendation; moderate quality of evidence).

A gluten-free diet is required (strong recommendation; moderate quality of evidence) to achieve the treatment goal of resolution of histologic mucosal lesions in adults (conditional recommendation; low quality of evidence).

Author/s:

Kerstin Austin, Nimrod Deiss-Yehiely, Jason T Alexander

A “no-biopsy” approach to diagnosing celiac disease

Aubrey Delammermore — Tue, 25 Oct 2022 05:00:00 +0000

Date Added:

October 25, 2022

Journal/Publication:

Journal of Family Practice

Publisher:

Frontline Medical Communications

Publication Date:

October 1, 2022

Issue:

Volume:

Pages:

359-361

URL:

A “no-biopsy” approach to diagnosing celiac disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.12788/jfp.0485

Keywords

celiac disease

Gastroenterology

diagnosis

Predictive Value of Tests

MeSH

World Health Organization

This antibody test is almost as good as a biopsy for diagnosing celiac disease. James W. Mold, MD, MPH

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PRACTICE CHANGER
CONSIDER A “NO-BIOPSY” APPROACH BY EVALUATING SERUM IMMUNOGLOBULIN (IG) A ANTI-TISSUE TRANSGLUTAMINASE (TTG-IGA) ANTIBODY TITERS IN ADULT PATIENTS WHO PRESENT WITH SYMPTOMS CONCERNING FOR CELIAC DISEASE (CD). AN INCREASE OF ≥ 10 TIMES THE UPPER LIMIT OF NORMAL (ULN) FOR TTG-IGA HAS A POSITIVE PREDICTIVE VALUE (PPV) OF ≥ 95% FOR DIAGNOSING CD WHEN COMPARED WITH ESOPHAGOGASTRODUODENOSCOPY (EGD) WITH DUODENAL BIOPSY—THE CURRENT GOLD STANDARD.

Author/s:

Mott, T., Gray, C., Storey, J.

Acid Suppression and Antibiotics Administered During Infancy Are Associated with Celiac Disease

Aubrey Delammermore — Sat, 22 Oct 2022 05:00:00 +0000

Date Added:

October 22, 2022

Journal/Publication:

The Journal of Pediatrics

Publisher:

Elsevier

Publication Date:

October 17, 2022

URL:

Acid Suppression and Antibiotics Administered During Infancy Are Associated with Celiac Disease

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.jpeds.2022.10.013

Keywords

Infancy

Retrospective Studies

children

prescriptions

celiac disease

PMID (1):

36265574

MeSH

celiac disease

International Classification of Diseases

anti-bacterial agents

proton pump inhibitors

child

Preschool

Another reason to exercise care when prescribing acid suppression and antibiotics in young children. James W. Mold, MD, MPH

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Objective
To investigate why certain at-risk individuals develop celiac disease, we examined the association of proton pump inhibitors (PPI), histamine-2 receptor antagonist (H2RA), and antibiotic prescriptions in the first six months of life with an early childhood diagnosis of celiac disease.
Study design
A retrospective cohort study was performed using the Military Healthcare System (MHS) database. Children with a birth record from October 1, 2001- September 30, 2013, were identified. Outpatient prescription records were queried for antibiotic, PPI, and H2RA prescriptions in the first 6 months of life. Cox proportional hazards regression was used to calculate the hazard ratio (HR) of developing CD based on medication exposure. ICD-9 codes identified children with an outpatient visit for celiac disease.
Results
968,524 children met inclusion criteria with 1,704 cases of celiac in this group. Median follow up for the cohort was about 4.5 years. PPI’s (HR, 2.23; 95% CI, 1.76-2.83), H2RA’s (HR, 1.94 95% CI, 1.67-2.26) and antibiotics (HR 1.14 95%CI 1.02-1.28) were all associated with an increased hazard of celiac disease.
Conclusion
There is an increased risk of developing celiac disease if antibiotics, PPI’s and H2RA’s are prescribed in the first 6 months of life. Our study highlights modifiable factors such as medication stewardship that may change the childhood risk of CD.

Author/s:

Boechler, M., Susi, A., Hisle-Gorman, E., Rogers, P. L., Nylund, C. M.

Diagnosis of Celiac Disease: Current State of the Evidence

Tracy Ashby — Tue, 23 Oct 2018 05:00:00 +0000

Date Added:

October 23, 2018

Journal/Publication:

AHRQ Comparative Effectiveness Reviews

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

July 26, 2016

URL:

Diagnosis of Celiac Disease: Current State of the Evidence

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

celiac disease

sensitivity and specificity

clinical decision-making

PMID (1):

27583323

MeSH

celiac disease

sensitivity and specificity

clinical decision-making

This is a summary of the evidence regarding how to diagnose celiac disease.

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This is a summary of a systematic review evaluating the evidence regarding the comparative accuracy (the balance of sensitivity and specificity) and possible adverse consequences (both direct and indirect) of various methods used to diagnose celiac disease. The systematic review included 60 individual studies and 13 previous systematic reviews published from January 1990 through March 2015. The full report, listing all studies and reviews, is available at www.effectivehealthcare.ahrq.gov/celiac-disease. This summary is provided to assist in informed clinical decisionmaking. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

Author/s:

John M. Eisenberg Center for Clinical Decisions and Communications Science