What’s new in the 2020 guidelines?

• For initial testing, the combination of total IgA and IgA class antibodies against transglutaminase 2 (TGA-IgA) is recommended as this is most accurate and cost-effective. EMA-IgA or DGP-IgG need not be tested initially

• The no-biopsy approach for CD diagnosis is confirmed to be safe in children with high TGAIgA values ≥10 times the upper limit of normal with accurate, appropriate tests and positive endomysial antibodies (EMAIgA) in a second serum sample

• Children with positive TGA-IgA but lower titers (<10 times upper limit of normal) should undergo biopsies to decrease the risk of false positive diagnosis.

• HLA testing and presence of symptoms are not obligatory criteria for a serology based diagnosis without biopsies