According to the American College of Gastroenterology, what is the best approach to evaluating and managing patients with celiac disease?
Although the American College of Gastroenterology recommends biopsies to diagnose celiac disease, it also states the combination of high titers of tissue transglutaminase and a positive endomysial antibody test are reliable alternatives. To achieve remission, a gluten-free diet (including gluten-free oats because of the prevalence of gluten contamination) remains the treatment of choice.
Plan de l'etude:
Self-funded or unfunded
The American College of Gastroenterology assembled a panel of content experts and methodology experts (no mention of participation by primary care clinicians, patients, or patient representatives) who identified 8 broad questions on evaluating and managing children and adults with celiac disease. They then addressed these questions via systematic reviews. The guideline has several useful tools, including a complex algorithm on the approach to a person with clinical suspicion of celiac disease. Although some of the recommendations are oriented toward gastroenterologists, the following are more relevant to primary care clinicians.
The panel strongly recommends that patients undergo esophagogastroduodenoscopy (EGD) with multiple biopsies. The panel also states that, in children and in adults unwilling to undergo EGD, the combination of high titers of tissue transglutaminase and a positive endomysial antibody test result are reliable alternatives. The panel recommends against mass screening in favor of case finding approaches to improve detection in the general population. While a gluten-free diet is the therapy of choice, gluten contamination of grains is problematic. The panel made a strong recommendation on using gluten-free oats to increase the likelihood of achieving clinical remission. Although there was dissension, the panel made a conditional recommendation against using gluten-detection devices. Finally, the panel found insufficient evidence to recommend for or against using probiotics.
Henry C. Barry, MD, MS
Michigan State University
East Lansing, MI