Send to

Choose Destination
United European Gastroenterol J. 2019 Jun;7(5):583-613. doi: 10.1177/2050640619844125. Epub 2019 Apr 13.

European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders.

Author information

Department of Gastroenterology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Department of Translational Medical Science, Section of Paediatrics, University of Naples, Naples, Italy.
Department of Paediatric Gastroenterology, Hospital Universitari Sant Joan de Reus, Universitat Rovira I Virgili, IISPV, Reus, Spain.
Gastroenterology and Liver Unit, Royal Hallamshire Hospital & University of Sheffield, Sheffield, UK.
Gastroenterology Department, Hôpital Européen Georges Pompidou, Paris, France.
Department of Gastroenterology, VU Medical Centre, Amsterdam, The Netherlands.
Department of Gastroenterology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
KG Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway.


This guideline presents recommendations for the management of coeliac disease (CD) and other gluten-related disorders both in adults and children. There has been a substantial increase in the prevalence of CD over the last 50 years and many patients remain undiagnosed. Diagnostic testing, including serology and biopsy, should be performed on a gluten-containing diet. The diagnosis of CD is based on a combination of clinical, serological and histopathological data. In a group of children the diagnosis may be made without biopsy if strict criteria are available. The treatment for CD is primarily a gluten-free diet (GFD), which requires significant patient education, motivation and follow-up. Slow-responsiveness occurs frequently, particularly in those diagnosed in adulthood. Persistent or recurring symptoms necessitate a review of the original diagnosis, exclude alternative diagnoses, confirm dietary adherence (dietary review and serology) and follow-up biopsy. In addition, evaluation to exclude complications of CD, such as refractory CD or lymphoma, should be performed. The guideline also deals with other gluten-related disorders, such as dermatitis herpetiformis, which is a cutaneous manifestation of CD characterized by granular IgA deposits in the dermal papillae. The skin lesions clear with gluten withdrawal. Also, less well-defined conditions such as non-coeliac gluten sensitivity (NCGS) and gluten-sensitive neurological manifestations, such as ataxia, have been addressed. Newer therapeutic modalities for CD are being studied in clinical trials but are not yet approved for use in practice.


Coeliac disease; coeliac neuropathy; dermatitis herpetiformis; enteropathy associated T-cell lymphoma; gluten ataxia; neurocoeliac; non-coeliac gluten sensitivity; refractory coeliac disease; seronegative coeliac disease; slow-responder coeliac

Supplemental Content

Full text links

Icon for Atypon Icon for PubMed Central
Loading ...
Support Center