Diagnosing and Managing Celiac Disease in Primary Care: Application of Current Guidelines An Expert Interview With Joseph A. Murray, MD Linda Brookes, MSc, Joseph A. Murray, MD Disclosures February 13, 2014

Background to the Interview

Celiac disease is recognized to be an inflammatory disorder of the small intestine with an autoimmune component and strong heritability. Once viewed primarily as a disease of childhood, occurring mainly in white persons, it is now understood to occur in people of any age and in populations outside Europe and North America. Previously considered a rare disease, the prevalence of celiac disease is currently estimated at 1 in 100-300 in most parts of the world, [1] and the incidence and prevalence have been increasing markedly over the past few decades. [2-5]

It has also become clear that celiac disease is associated with many other nongastrointestinal signs and symptoms and strongly associated with autoimmune diseases such as type 1 diabetes.

As a result of advances in the understanding and diagnosis of celiac disease, major guidelines have been updated recently, including those issued by the American College of Gastroenterology (ACG), [6] European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN), [7] the British Society of Pediatric Gastroenterology, Hepatology, and Nutrition/Coeliac UK, [8] and the World Gastroenterology Organisation.[1] The US and European guidelines differ in their emphasis on the relative importance of serologic, genetic, and histologic testing in diagnosis, but all of the recommendations aim at achieving high diagnostic accuracy and improving rates of diagnosis.

The detection and management of celiac disease increasingly involve general practice. At the same time, diagnostic algorithms are becoming more complicated, requiring specialized knowledge apart from procedures and biopsies. [9]

To further assist primary care providers (PCPs), Dr. Murray spoke to Medscape about the guidance provided by the latest guidelines for diagnostic strategies in the primary care setting for patients with suspected celiac disease. Management after diagnosis, with particular attention to strategies used in primary care, was also discussed. Dr. Murray is coauthor of the latest guidelines on diagnosis and management of celiac disease issued by the ACG [6] and previously the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. [10] He is also senior author of international guidelines on the use of video capsule endoscopy in celiac disease [11] as well as many editorials and reviews on diagnosis, treatment, and management of the disease.


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