Celiac disease, affecting approximately 1% of the US population, is an immune-mediated response to gluten, leading to small bowel mucosa injury, villous atrophy, and subsequent malabsorption of essential nutrients. Common symptoms include diarrhea, abdominal discomfort, and bloating, while extraintestinal manifestations can include fatigue, weight loss, and osteoporosis.
Key Highlights from the 2023 ACG Guidelines:
- The guidelines were developed by content and methodology experts using the GRADE framework to assess evidence and recommendation strength. The literature review followed the PICO format, although formal search details were not reported.
- Recommendations were categorized as strong or conditional, with evidence quality rated from high to very low. Of the 11 recommendations, six were strong, based on moderate to low-quality evidence.
- Routine screening for celiac disease in asymptomatic individuals is not recommended. Evaluation should be considered in the presence of chronic diarrhea, abdominal pain, unexplained weight loss, and specific nutrient deficiencies. The sensitivity and specificity of symptoms like diarrhea vary widely, indicating the need for a cautious and thorough diagnostic approach.