Abstract：
This guideline presents an update to the 2013 American College of Gastroenterology Guideline on the Diagnosis and Management of Celiac Disease with updated recommendations for the evaluation and management of patients with celiac disease (CD). CD is defined as a permanent immune-mediated response to gluten present in wheat, barley, and rye. CD has a wide spectrum of clinical manifestations that resemble a multisystemic disorder rather than an isolated intestinal disease, and is characterized by small bowel injury and the presence of specific antibodies. Detection of CD-specific antibodies (e.g., tissue transglutaminase) in the serum is very helpful for the initial screening of patients with suspicion of CD. Intestinal biopsy is required in most patients to confirm the diagnosis. A nonbiopsy strategy for the diagnosis of CD in selected children is suggested and discussed in detail. Current treatment for CD requires strict adherence to a gluten-free diet (GFD) and lifelong medical follow-up. Most patients have excellent clinical response to a GFD. Nonresponsive CD is defined by persistent or recurrent symptoms despite being on a GFD. These patients require a systematic workup to rule out specific conditions that may cause persistent or recurrent symptoms, especially unintentional gluten contamination. Refractory CD is a rare cause of nonresponsive CD often associated with poor prognosis.
摘要：
本指南更新了2013年美国胃肠病学会乳糜泻诊断和管理指南，并更新了乳糜泻（CD）患者的评估和管理建议。CD被定义为对小麦中存在的麸质的永久性免疫介导的反应，大麦,还有黑麦.CD具有广泛的临床表现，类似于多系统疾病，而不是孤立的肠道疾病。表现为小肠损伤和特异性抗体的存在。CD特异性抗体的检测（例如，血清中的组织转谷氨酰胺酶）对于怀疑CD的患者的初步筛查非常有帮助。大多数患者需要进行肠活检以确认诊断。建议并详细讨论了在某些儿童中诊断CD的非活检策略。目前的CD治疗需要严格遵守无麸质饮食（GFD）和终身医学随访。大多数患者对GFD具有优异的临床反应。无反应性CD定义为持续或反复出现的症状，尽管患有GFD。这些患者需要进行系统的检查，以排除可能导致持续或复发症状的特定情况。尤其是无意的麸质污染。难治性CD是无反应性CD的罕见原因，通常与预后不良有关。
