What are the 2013 American College of Gastroenterology (ACG) guidelines for the diagnosis and treatment of celiac disease (sprue)?

Updated: Nov 29, 2019
  • Author: Stephan U Goebel, MD; Chief Editor: BS Anand, MD  more...
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In 2013, The American College of Gastroenterology (ACG) issued clinical guidelines regarding the diagnosis and treatment of celiac disease, including the following [2] :

  • Patients should be tested prior to being placed on a gluten-free diet

  • Antibody testing, especially immunoglobulin A anti-tissue transglutaminase antibody (IgA TTG), is the best first test, although biopsies are needed for confirmation; in children younger than 2 years, the IgA TTG test should be combined with testing for IgG-deamidated gliadin peptides

  • Patients diagnosed with celiac disease should be examined for deficiencies, including low bone density (BMD)

  • Patients already on a gluten-free diet without prior testing need to be evaluated to assess the likelihood that celiac disease is present; genetic testing and a gluten challenge are most helpful

  • Patients in whom celiac disease is highly likely despite absence of prior testing should be treated as though they have the disease

  • Although most patients get better on a gluten-free diet, a systematic evaluation is needed for those who do not

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