The European Society for the Study of Coeliac Disease (ESsCD) has published new guidelines for the diagnosis and management of coeliac disease (CD) and other gluten-related disorders in adults and children.
Advice is provided on who should be tested for CD and how, with the authors recommending that diagnostic testing, including serology and biopsy, should be performed while the patient is consuming a gluten-containing diet.
IgA-tissue transglutaminase (TG2) antibody is the preferred single test for detection of CD at any age, while duodenal biopsy is recommended to confirm the diagnosis of CD in adults. The authors recommend that if CD is highly suspected, duodenal biopsy should be done even if serology is negative.
The authors recommend newly diagnosed adult patients should undergo testing to uncover deficiencies of essential micronutrients. Patients at risk of osteoporosis should undergo baseline bone density measurement (DEXA) either at diagnosis or not later than the age of 30-35 years. The authors recommend the use of intravenous bisphosphonates in documented cases of osteoporosis in newly diagnosed CD "to overcome the uncertainty about absorption of medications".
Patients with a slow response should be evaluated carefully to exclude dietary inconsistencies and identify other specific aetiologies.
The guidelines are published in the United European Gastroenterology Journal.