CLINICAL GUIDELINESCMEAmerican College of Gastroenterology GuidelinesUpdate:Diagnosis and Management of Celiac DiseaseAlberto Rubio-Tapia,MD',Ivor D.Hill,MD2,Carol Semrad,MD3,Ciaran P.Kelly,MDand Benjamin Lebwohl,MD,MS5This guideline presents an update to the 2013 American College of Gastroenterology Guideline on the Diagnos is andManagement of Celiac Disease with updated recommendations for the evaluation and management of patients with celiacdisease(CD).CD is defined as a permanent immune-mediated response to gluten present in wheat,barley,and rye.CD hasawide spectrum of clinical manifestations that resemble a multisystemic disorder rather than an isolated intestinal disease,and is characterized by small bowel injury and the presence of specific antibodies.Detection ofCD-specific antibodies (e.g.,tissue transglutaminase)in the serum is very helpful for the initial screening of patients with suspic ion of CD.Intestinalbiopsy is required in most patients to confirm the diagnosis.A nonbiopsy strategy for the diagnosis of CDin selected childrenis suggested and discussed in detail.Current treatment for CD requires strict adherence to a gluten-free diet(GFD)andlifelong medical follow-up.Most patients have excellent clinical response to a GFD.Nonresponsive CD is defined bypersistent or recurrent symptoms despite being on a GFD.These patients require a systematic workup to rule out specificconditions that may cause persistentorrecurrent symptoms,especially unintentionalgluten contamination.Refractory CDisa rare cause of nonresponsive CD often associated with poor prognosis.SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/C755Am J Gastroenterol 2023:118:59-76.https//doiorg/10.14309/ajg.0000000000002075:published online September 21.2022INTRODUCTIONfollow-up of patients with CD(Tables 1 and 2).This guideline isGuiding principlesintended for healthcare providers who care for patients with CD.This document presents official recommendations from theAmerican College ofGastroenterology(ACG)on the diagnosis,Backgroundmanagement,and follow-up of celiac disease(CD)in childrenThis guideline presents an update to the 2013 ACG Guidelines:and adults.This guideline was developed in compliance withDiagnosis and Management of CD with updated recommenda-the Institute of Medicine standards for practice guidelinestions for the evaluation and management of patients with CD(1).and uses the Grading of Recommendation Assessment De-CD affects nearly 1%of residents of the United States(2).CD isvelopment and Evaluation(GRADE)approach.The primarydefined as a permanent immune-mediated response to glutenobjective is to produce high-quality evidence-based clinicalpresent in wheat,barley,and rye (3).CD has a wide spectrum ofpractice guidelines to answer common clinical questions anddinical manifestations that resemble a multisystemic disorderimprove health care.rather than an isolated intestinal disease.CD is characterized byThe guideline evaluates a broad sp
