UEG's educational platform for gastroenterology education bringing recordings, courses, guidelines, and more together in one place.

UEG Week Berlin 2025 Recordings Gut Guide online

Rate for better recommendations!

Your feedback helps us show you more of what you like and less of what you dislike!

More of this!

We will show you more similar content.

Not for me!

We won't suggest this again.

Bookmark!

Save this content for later!

New to myUEG? Create an account! Log In with myUEG account

UEG Poster

Standard Poster

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Free for all myUEG account holders. Your access level is set automatically based on your occupation. Medical professionals get full access to all content. If you are a non-medical user, you can only access UEG Week content from congresses you attended.

Not sure what you can access? Learn more about account types.

Introduction

Despite mounting evidence supporting a no-biopsy approach for the diagnosis of coeliac disease in adults, established clinical pathways in primary and secondary care could hinder implementation in clinical practice. The aim of this study was to identify the barriers and facilitators to a no-biopsy diagnostic pathway of coeliac disease in primary and secondary care.

Aims & Methods

We conducted a qualitative study using semi-structured interviews with gastroenterologists and general practitioners (GPs). We used a pre-defined interview topic guide consisting of open-ended questions and prompts to facilitate discussion about the views of primary and secondary care physicians on the no-biopsy diagnosis of coeliac disease in adults. The interviews were conducted in person or virtually, then transcribed verbatim and analysed using reflexive thematic analysis.

Results

We interviewed 24 physicians (12 gastroenterologists and 12 GPs) across England between February and March 2024. Participants (62.5% male, 58.3% from North of England, and 50% non-white) had different levels of experience ranging between 2 and 30 years. Gastroenterologists were more aware of the no-biopsy approach and the evidence supporting it compared with GPs (100% vs. 50%, p=0.01). Both groups were supportive of the no-biopsy approach but acknowledged the lack of clear guidelines as a major barrier to implementation in clinical practice. Increased patient satisfaction, shorter waiting times to start treatment, and reduced endoscopy services pressures and costs were perceived as the main advantages of the no-biopsy approach. However, participants had concerns regarding false positive results, missing concurrent pathology, dealing with persistent symptoms after treatment without biopsy confirmation, and the increased workload in primary care.

Conclusion

Primary and secondary physicians are willing to adopt a serology-based diagnosis of coeliac disease in adults. The safe and effective implementation of this no-biopsy approach depends on developing clear evidence-based clinical guidelines and referral pathways, along with comprehensive education for all healthcare providers involved.

EXPLORING THE VIEWS OF PRIMARY AND SECONDARY CARE PHYSICIANS ON THE NO-BIOPSY DIAGNOSIS OF COELIAC DISEASE IN ADULTS: A QUALITATIVE INTERVIEW STUDY

Mohamed G. Shiha 1, Freya J Bowker-Howell 1, Alice M Harper 2, Martha Elwen 2, Hugo Penny 1, Jonathan Banks 2, David S. Sanders 1

1 Sheffield Teaching Hospitals, Sheffield, United Kingdom|||University of Sheffield, Sheffield, United Kingdom

2 University of Bristol, Bristol, United Kingdom

Conference

UEG Week Vienna 2024

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

SMALL INTESTINAL (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Standards and Guidelines

New

Clinical Practice Guideline

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Not sure what you can access? Learn more about account types.

ABSTRACT

Introduction

Since the publication of the first European Society for the Study of Coeliac Disease (ESsCD) guidelines in 2019, substantial advances have been made in understanding the management and complex disease courses of coeliac disease (CeD) in adults. These 2025 updated guidelines aim to integrate new evidence, refine management strategies, and promote a personalised and multidisciplinary approach to care.

Methods

The ESsCD convened a multidisciplinary panel of experts to revise the 2019 guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework. Evidence was appraised and graded according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Statements and recommendations were draughted within working groups and finalised through a structured Delphi consensus process.

Results

The updated guidelines are presented in two parts. Part 1, which has already been published, addresses the diagnostic approach to CeD in adults, whereas Part 2 focuses on disease management, structured follow-up, and the evaluation and treatment of persistent symptoms despite a gluten-free diet or refractory disease. New or expanded sections include guidance on the safe inclusion of oats, use of low-FODMAP diets in patients with persistent symptoms, management of exocrine pancreatic insufficiency, recognition of functional asplenia and related vaccination recommendations, and stratified bone-health screening. The guidelines also discuss nutritional and psychosocial support, digital models of care, and structured transition from paediatric to adult services. Updated therapeutic strategies for refractory CeD are provided, including immunosuppressive and novel pharmacologic options.

Conclusions

These updated guidelines offer a comprehensive, evidence-based framework for the management and follow-up of adults with CeD. By integrating recent scientific advances with pragmatic, patient-centred recommendations, they seek to optimise clinical outcomes, quality of life, and long-term health in individuals with CeD.

European Society for the Study of Coeliac Disease (ESsCD) 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 2: Management, Follow-Up, and Complex Disease Courses

Abdulbaqi Al-Toma

Guideline

Clinical Practice Guideline

Topics

Immunology Small Intestine & Nutrition

Citation

United European Gastroenterology Journal, 2026

Published

2026

UEG Podcast Episode

UEG Podcast

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Not sure what you can access? Learn more about account types.

Coeliac disease with David Sanders

David S. Sanders, Pradeep Mundre

Topics

Small Intestine & Nutrition

Published

2026

UEG Standards and Guidelines

Clinical Practice Guideline

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Not sure what you can access? Learn more about account types.

ABSTRACT

Introduction

Since the publication of the first European Society for the Study of Coeliac Disease (ESsCD) guidelines in 2019, significant advancements have emerged in the diagnosis of coeliac disease (CeD) in adults. These 2025 guidelines incorporate new evidence to refine diagnostic strategies, aiming for improved accuracy of testing, and enhance overall quality of clinical care.

Methods

A multidisciplinary panel of experts revised the ESsCD guidelines using the AGREE II instrument (Appraisal of Guidelines for Research and Evaluation II) and the GRADE methodology (The Grading of Recommendations Assessment, Development, and Evaluation). Clinical questions were structured using the PICO format, and statements and recommendations were finalised through a Delphi consensus process. Literature quality was assessed using AMSTAR-2 and QUADAS-2 tools.

Results

The updated guidelines are presented in two parts. Part 1 focuses on adult CeD diagnosis, introducing major changes such as a conditional no-biopsy approach for selected adults with high-titre IgA anti-TG2 serology (≥ 10 × ULN). Regarding serology, the use of validated high-performance ELISAs displaying a high diagnostic accuracy is emphasised, while routine use of IgA anti-Endomysium serology is no longer recommended for confirmation. Revised duodenal biopsy protocols now mandate at least four samples from the second part of the duodenum, with bulb biopsies conditionally included. The guidelines provide structured approaches for diagnosing potential CeD, seronegative villous atrophy, and CeD in individuals already on a gluten-free diet. HLA-DQ2/DQ8 typing is recommended for diagnostic clarification in select cases.

Conclusions

The updated 2025 ESsCD guidelines provide a comprehensive framework for the diagnosis of CeD in adults. By integrating evolving diagnostic strategies, minimising over-testing, and patient-centred care approaches, they aim to optimise patient outcomes, quality of life and use of diagnostic resources at the same time.

European Society for the Study of Coeliac Disease 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 1: Diagnostic Approach

Abdulbaqi Al-Toma

Guideline

Clinical Practice Guideline

Topics

Small Intestine & Nutrition

Citation

United European Gastroenterology Journal; 2025; 00:1–32

Published

2025

UEG Online Course

accredited

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Not sure what you can access? Learn more about account types.

Coeliac disease is a highly prevalent condition that, if left untreated, can be a major cause of morbidity worldwide. There is also increasing awareness of the role of a gluten-free diet in the management of patients with noncoeliac gluten sensitivity.

This online course provides the latest information on the diagnosis and management of coeliac disease and gluten-related disorders. Authors Stefania Chetcuti Zammit and David S. Sanders discuss the pathophysiology, epidemiology, symptoms, endoscopic features and extraintestinal manifestations of coeliac disease. They describe the general diagnostic approach to serology negative villous atrophy and present a diagnostic algorithm. Treatment options are also summarized, and awareness raised of the complications in patients with refractory coeliac disease.

The course includes comprehensive PPT slides and bespoke video presentations, which were filmed in June 2022. The estimated time needed to complete the course, including the final assessment, is 60 minutes

Target audience

This course is designed for gastroenterologists in training, other doctors with a special interest in coeliac disease, nurses (including nutrition nurses), dietitians, medical students and other health-care professionals looking after patients with coeliac disease or related disorders.

The diagnosis and management of coeliac disease and gluten-related disorders

David S. Sanders, Stefania Chetcuti Zammit

Event

The diagnosis and management of coeliac disease and gluten-related disorders

Topics

Small Intestine & Nutrition

Accreditation status

accredited

Duration

50 minutes

Published

2022

UEG Mistakes In Articles

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Not sure what you can access? Learn more about account types.

Coeliac disease is an autoimmune disorder triggered by gluten, which activates an immune reaction against the autoantigen tissue transglutaminase (TG2) in genetically predisposed subjects. Genetic susceptibility to coeliac disease has been proven by its close linkage with major histocompatibility complex (MHC) class II human leukocyte antigen (HLA) DQ2 and DQ8 haplotypes. The identification of biomarkers for coeliac disease (e.g. endomysial antibodies [EmA] and antibodies to TG2 [anti-TG2]) has changed the epidemiology of coeliac disease from being a rare to a frequent condition, with an expected prevalence of 1% in the worldwide population. Coeliac disease can be difficult to diagnose because symptoms vary from patient to patient, and the majority of patients who have coeliac disease remain undiagnosed. Small intestinal biopsy remains the gold standard for coeliac disease diagnosis, and a delayed diagnosis in the elderly can be considered a risk factor for complications. Complicated coeliac disease is not so frequent, but for those who have it, the prognosis is very poor, with a low rate of survival after 5 years.