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New Guidelines for Screening and Testing for Celiac DIsease

The American College of Gastroenterology has issued new guidelines for screening and testing for Celiac Disease.  The hope is that these guidelines may lead to earlier and more definitive diagnosis of CD.  Below are some of the highlights of the new recommendations.  (For more specifics on testing, read our article here.)


As Gluten Freedom Project users know, many people go years without receiving a diagnosis of Celiac Disease because this illness can manifest in many different ways.  The ACG is now recommending Celiac screening for anyone with elevated liver enzymes, as well as children diagnosed with Down’s Syndrome.  These populations have higher incidence of CD, even though they may not have overt intestinal symptoms.


One of the greatest things about the new guidelines is that they take into account the pros and cons of different testing methods.  Intestinal biopsy is considered a gold standard for identifying CD.  But it is now recognized that the accuracy of the biopsy depends largely on how many samples were taken and the specific regions of the gut from which the biopsy was removed.  If specimens are not collected from specific regions of the gut, it may be difficult for even experienced pathologists to definitely determine if a person has CD. 

The new ACG guidelines specify:

  • Four biopsies should be taken from the second and third portions of the duodenum (a region of the small intestine), PLUS
  • One to two biopsies removed from the duodenal bulb, which is the region of the duodenum that is closest to the stomach

Blood Test

Researchers now understand that using the anti-gliadin antibody test alone is not sufficient for confirming or denying the presence of CD. 

  • More accurate metrics are available such as the TTG IgA  (tissue transglutaminase) antibody test.
  • Under the new guidelines it is recognized that for a significant percentage of the CD population, even the TTG IgA antibody test will be inaccurate due to IgA insufficiency.   For these people, tests such as IgG TTG or GDP will be better markers.
  • Finally, it is now recognized that the accuracy of both tests and biopsy decreases if a person has been following a gluten-free diet.  In these cases, it is important to look at the genetic HLA-DQ2 and DQ8 markers to assess the likelihood of CD.  These genetic metrics should be used in combination with blood tests and biopsies to get a sense if CD is an accurate diagnosis.


Last but not least, the new guidelines officially recognize that it is important to get newly diagnosed CD patients to a dietician or other nutrition professional.    Most people with CD have a number of nutrient deficiencies that need to be corrected with diet and supplementation.  If these nutrient deficiencies are not remedied it will be difficult to fully heal the digestive tract and restore health. is a wonderful resource in this area.  All of the meal plans at GFP were designed by dieticians and nutritionists.  They focus on nutrient density so you get the biggest nutritional bang for every bite.

Many people live with undiagnosed Celiac Disease for years because they do not manifest the typical symptoms for the disease, or because they underwent testing that was insufficient.  The new recommendations set forth from the American College of Gastroenterology will hopefully ensure that those living with CD will be diagnosed sooner and more accurately.  This will allow patients to get effective treatment and begin to restore their health. 

Click here to read more about these guidelines.