Celiac Flashcards
(8 cards)
Should a combination of noninvasive serology tests vs duodenal biopsy be used to confirm the diagnosis of CD in children and adults?
a) We recommend EGD w/ multiple duodenal biopsies for confirmation of diagnosis in both children and adults w/ suspicion of CD (strong, moderate evidence)
b) Suggest a combination of high-level TTG IgA (> 10x ULN) w/ a positive EMA in a second blood sample as reliable tests for diagnosis of CD in children. In symptomatic adults unwilling or unable to undergo EGD, the same criteria may be considered after the fact, as a diagnosis of likely CD (conditional, moderate evidence
Should intestinal mucosa healing vs clinical and serological remission be used as a goal of GFD therapy to improve long-term outcomes (5 yr or more) such as mortality, cancer risk, and osteoporosis in adults w/ CD?
Suggest setting a goal of intestinal healing as an end-point of GFD therapy. We advocate for individualized discussion of goals of the GFD w/ the patient beyond clinical and serological remission (conditional, low evidence)
Should gluten detection devices vs current standard of care be used to monitor adherence to GFD and/or patients’ dietary decision-making?
Suggest against routine use of gluten detection devices in food or biospecimens among patients w/ CD (conditional, low evidence)
In patients w/ CD, what is the effect of probiotics in additional to GFD on the rates of clinical remission and mucosal healing compared w/ GFD alone?
There is insufficient evidence to recommend for or against the use of probiotics for the treatment of CD
In patient w/ newly diagnosed CD, what is the effect of GFD w/o oats on increasing the rate of clinical remission and mucosal healing compared w/ GFD w/ oats?
Recommend consumption of gluten free oats in the diet of those w/ CD. Gluten contamination of oats, variable toxicity in different varieties of oats, and the small risk for an immune reaction to the oat protein avenue requires monitoring for oat tolerance (strong, moderate)
For patients w/ CD, does the use of pneumococcal vaccine reduce the future risk of serious pneumococcal infection compared w/ no vaccine?
Suggest vaccination to prevent pneumococcal disease in patients w/ CD (conditional, low evidence)
Should case finding vs mass screening be used to improve detection of CD in the general population?
a) Recommend case finding to increase detection (strong, low evidence)
b) Recommend against mass screening for CD in the community (strong, low evidence)
Are TTG and DGP antibodies in combination more accurate in diagnosing CD in children younger than 2 yrs old compared w/ TTG alone?
a) Recommend the immunoglobulin IgA anti-TTGA-IgA as the preferred single test for detection of CD in children younger than 2 yr who are not IgA deficient (strong, moderate evidence)
b) Recommend that testing for CD in children w/ IgA deficiency be performed using IgG-based antibodies (DGP-IgG or TTG-IgG) (strong, moderate evidence)
