My patient has positive celiac disease serologies but is declining or cannot tolerate a biopsy to confirm celiac disease
**NOTE TO PROVIDERS REGARDING THIS SECTION: While other international societies such as the European Society for Pediatric Gastroenterology, Hepatology and Nutrition have published evidence-based guidelines^(#fhir-question-154e033da684832eef8780b02200886f)^ providing for diagnosis of celiac disease in children based upon serologic and clinical criteria alone, according to current NASPGHAN guidelines for the diagnosis of celiac disease^(#fhir-question-9a07d0cc3fa9e5ae3d6b34e018d666a1),(#fhir-question-9231a113a2544f625c3e0970bc3af532)^, the gold standard for celiac disease diagnosis remains a small bowel biopsy. Recognizing that many families may still decline this guidance, this section is intended to aid providers in better clarifying the diagnosis when biopsy data are not available. With the rare exception of those who may not tolerate the required procedure, a small bowel biopsy should be offered and recommended to all patients with possible or probable celiac disease prior to gluten exclusion.**
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Villalta D, Tonutti E, Prause C, Koletzko S, Uhlig HH, Vermeersch P, et al. IgG antibodies against deamidated gliadin peptides for diagnosis of celiac disease in patients with IgA deficiency. Clinical chemistry. 2010;56(3):464-8. doi: 10.1373/clinchem.2009.128132. PubMed PMID: 20022984.
Absah I, Rishi AR, Gebrail R, Snyder MR, Murray JA. The Lack of Utility of Anti-tTG IgG in the Diagnosis of Celiac Disease When Anti-tTG IgA Is Negative. Journal of pediatric gastroenterology and nutrition. 2016. doi: 10.1097/MPG.0000000000001351. PubMed PMID: 27472475.
Cataldo F, Lio D, Marino V, Picarelli A, Ventura A, Corazza GR. IgG(1) antiendomysium and IgG antitissue transglutaminase (anti-tTG) antibodies in coeliac patients with selective IgA deficiency. Working Groups on Celiac Disease of SIGEP and Club del Tenue. Gut. 2000;47(3):366-9. PubMed PMID: 10940273; PubMed Central PMCID: PMC1728054.
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The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) acknowledges content contributions to the Site provided by: The NASPGHAN Clinical Care and Quality Committee, including Norelle Reilly (content author), KT Park (committee chair), Binita Kamath (NASPGHAN councilor), Ashish Chogle, Kristin Fiorino, Iona Monteiro and Edward Hoffenberg; the NASPGHAN Technology Committee, including John Pohl (committee chair), James Bayrer, Daniel Mallon, Douglas Mogul, and Neha Santucci; and the following individuals for providing additional contributions and editorial oversight: Ivor Hill, Stefano Guandalini, Edwin Liu, Ritu Verma, Joseph Levy, Alessio Fasano, and Edward Hoffenberg. NASPGHAN would also like to gratefully recognize Marilyn Geller and the Celiac Disease Foundation for their generous funding contributions and for producing the Site.