Current Recommendations for Diagnosis of Celiac Disease

Celiac disease (CeD) diagnosis traditionally relies on detecting serum antibodies against gluten, transglutaminase 2, and anti-endomysial antibodies, as well as confirming mucosal damage via intestinal biopsy. While serology is useful in diagnosing CeD, guidelines for adults often recommend an upper endoscopy and duodenal biopsy to assess mucosal atrophy. Human leukocyte antigens (HLA) testing is also valuable; Histology remains essential in presence of low-titer serology. In the presence of serology positive at high titers, in children and adults CeD cases can be diagnosed without biopsy. A gluten challenge may be necessary for accurate diagnosis in individuals already on a gluten-free diet. Research is in progress to develop less invasive diagnostic methods.