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Gastroenterology1410 papers

Celiac disease

Last edited: 4/13/2026

Overview

Celiac disease is an immune-mediated disorder triggered by gluten in genetically susceptible individuals, leading to small intestinal inflammation and malabsorption 129.

Diagnosis

  • Serological testing: Anti-tissue transglutaminase (tTG) IgA antibodies and endomysial antibodies are primary markers 21659.
  • Biopsy confirmation: Duodenal biopsy showing villous atrophy is traditionally required, though high tTG titers may suffice in some cases 1659.
  • Biopsy-sparing approaches: Considered in pediatrics with high antibody titers, reducing need for invasive procedures 33.
  • Genetic testing: HLA-DQ2 and HLA-DQ8 genotyping can support diagnosis but is not diagnostic alone 11131.

    • Management

  • Gluten-free diet (GFD): Strict lifelong adherence is essential 9131928.
  • Nutritional support: Regular monitoring for micronutrient deficiencies (vitamin D, iron, folate, B12) and supplementation as needed 4514192848.
  • Dietitian involvement: Essential for proper dietary education and management 1.
  • Follow-up: Regular assessment to ensure adherence and nutritional status 1319.

    • Special Populations

  • Pregnancy: Monitor for tTG-IgA seroprevalence and associated maternal and infant health risks 3.
  • Pediatrics: Early diagnosis and strict GFD are crucial to prevent long-term complications; adherence to ESPGHAN guidelines improves outcomes 2182433.
  • Comorbidities: Increased risk of depression, anxiety, and other neuropsychiatric conditions; consider multidisciplinary care 2244.

    • Key Recommendations

  • Implement serological testing for tTG IgA and endomysial antibodies for diagnosis, followed by biopsy if indicated 216 (Evidence: Strong).
  • Initiate strict lifelong gluten-free diet upon diagnosis to manage symptoms and prevent complications 913 (Evidence: Strong).
  • Regular nutritional assessment and supplementation for micronutrient deficiencies, particularly vitamin D and B vitamins 41419 (Evidence: Moderate).
  • Engage dietitian support for optimal dietary management 1 (Evidence: Expert opinion).
  • Monitor pediatric patients closely for adherence and nutritional status, adhering to ESPGHAN guidelines 1824 (Evidence: Moderate).

    • References

    1 Palmer M, MacDermott P, Patel B, McIvor C, Purcell L. Does A Dietitian-Led Celiac Disease Clinic (DLCC) Facilitate Timely Diagnosis and Nutrition Care for Patients With Celiac Disease?. Journal of gastroenterology and hepatology 2025. link 2 Litwin A, Le Thi TG, El-Lababidi N, Kindermann A, Pancheva R, Gerasimidis K et al.. Celiac disease diagnosis in clinical practice: ESPGHAN quality of care survey from 129 pediatric hospitals across 28 countries. Journal of pediatric gastroenterology and nutrition 2025. link 3 Cirillo PM, Venkatesh RD, Iscol JJ, Sangal K, Krigbaum NY, Zimmermann LM et al.. Pregnancy Antitissue Transglutaminase Immunoglobulin A Seropositivity and Maternal and Infant Health in the Child Health and Development Studies. The American journal of gastroenterology 2025. link 4 Nuermaimaiti K, Li T, Li N, Shi T, Liu W, Abulaiti P et al.. Vitamin and trace elements imbalance are very common in adult patients with newly diagnosed Celiac disease. Scientific reports 2025. link 5 Al-Hussaini A, Troncone R, Alobaid S, Bashir MS. Status of vitamins and minerals in children with screening-identified celiac disease: A case-control study. Journal of pediatric gastroenterology and nutrition 2024. link 6 Marino M, Galeazzi T, Gesuita R, Ricci S, Catassi C, Cherubini V et al.. Differences in Plasma 25-Hydroxyvitamin D Levels at Diagnosis of Celiac Disease and Type 1 Diabetes. Nutrients 2024. link 7 Yoosuf S, Singh P, Khaitan A, Strand TA, Ahuja V, Makharia GK. Prevalence of Celiac Disease in Patients With Liver Diseases: A Systematic Review and Meta-Analyses. The American journal of gastroenterology 2023. link 8 Jena A, Kumar-M P, Kumar A, Birda CL, Choudhury A, Kumar N et al.. Liver abnormalities in celiac disease and response to gluten free diet: A systematic review and meta-analysis. Journal of gastroenterology and hepatology 2023. link 9 Rubio-Tapia A, Hill ID, Semrad C, Kelly CP, Greer KB, Limketkai BN et al.. American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease. The American journal of gastroenterology 2023. link 10 Crocco M, Calvi A, Canzoneri F, Malerba F, Zampatti N, Chiaro A et al.. The Influence of SARS-CoV-2 Pandemic on the Diagnosis of Celiac Disease and Clinical Practice in Pediatric Gastroenterology. Nutrients 2023. link 11 Roldan GA, Jamot S, Kopec K, Charoen A, Leffler D, Feller ER et al.. Celiac Disease Presenting in a Community-Based Gastroenterology Practice: Obesity and Bone Disease Are Common. Digestive diseases and sciences 2023. link 12 van Megen F, Fossli M, Skodje GI, Carlsen MH, Andersen LF, Veierød MB et al.. Nutritional assessment of women with celiac disease compared to the general population. Clinical nutrition ESPEN 2023. link 13 Martín-Masot R, Jiménez-Muñoz M, Herrador-López M, Flor-Alemany M, Navas-López VM, Nestares T. The Importance of an Early Evaluation after Establishing a Gluten-Free Diet in Children with Celiac Disease. Nutrients 2023. link 14 van der Velde LA, Beth SA, Voortman T, van Zelm MC, Moll HA, Kiefte-de Jong JC. Anti-tissue transglutaminase antibodies (TG2A) positivity and the risk of vitamin D deficiency among children - a cross-sectional study in the generation R cohort. BMC pediatrics 2023. link 15 Green PHR, Paski S, Ko CW, Rubio-Tapia A. AGA Clinical Practice Update on Management of Refractory Celiac Disease: Expert Review. Gastroenterology 2022. link 16 Mott T, Gray C, Storey J. A "no-biopsy" approach to diagnosing celiac disease. The Journal of family practice 2022. link 17 Martinez Santos Y, Camo Monterde P, Badía Martínez M, Espina Cadena S. Celiac patient satisfaction with nursing consultations in a gastroenterology department. Revista espanola de enfermedades digestivas 2022. link 18 Horton RK, Hagen CE, Snyder MR. Pediatric Celiac Disease: A Review of Diagnostic Testing and Guideline Recommendations. The journal of applied laboratory medicine 2022. link 19 Jivraj A, Hutchinson JM, Ching E, Marwaha A, Verdu EF, Armstrong D et al.. Micronutrient deficiencies are frequent in adult patients with and without celiac disease on a gluten-free diet, regardless of duration and adherence to the diet. Nutrition (Burbank, Los Angeles County, Calif.) 2022. link 20 Girish BN, Rajesh G, Vaidyanathan K. Deficiency of folate and vitamin B. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 2022. link 21 Alhosain AI, Alshammari GM, Almoteri BL, Mohammed MA, Binobead MA, Yahya MA. Long-Term Effect of Gluten-Free Diets on Nutritional Status, Body Composition, and Associated Factors in Adult Saudi Females with Celiac Disease. Nutrients 2022. link 22 Sharma N, Singh K, Senapati S. Celiac disease poses significant risk in developing depression, anxiety, headache, epilepsy, panic disorder, dysthymia: A meta-analysis. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 2021. link 23 Paul SP, Balakumar V, Gillett PM. Celiac Disease Management in the United Kingdom Specialist Pediatric Gastroenterology Centers-A Service Survey. Journal of pediatric gastroenterology and nutrition 2021. link 24 Lau WS, Heaton PA, Paul SP. IMPROVED ADHERENCE TO THE ESPGHAN GUIDELINES IS NECESSARY FOR DIAGNOSING CELIAC DISEASE IN CHILDREN: A SINGLE-CENTER EXPERIENCE. Arquivos de gastroenterologia 2021. link 25 Di Biase AR, Marasco G, Ravaioli F, Colecchia L, Dajti E, Lecis M et al.. Clinical Presentation of Celiac Disease and Diagnosis Accuracy in a Single-Center European Pediatric Cohort over 10 Years. Nutrients 2021. link 26 Das P, Vaiphei K, Amarapurkar AD, Sakhuja P, Nada R, Paulose RR et al.. Best practices of handling, processing, and interpretation of small intestinal biopsies for the diagnosis and management of celiac disease: A joint consensus of Indian association of pathologists and microbiologists and Indian society of gastroenterology. Indian journal of pathology & microbiology 2021. link 27 Dembiński Ł, Mazur A, Dąbrowski M, Jackowska T, Banaszkiewicz A. Knowledge of Medical Students and Medical Professionals Regarding Nutritional Deficiencies in Patients with Celiac Disease. Nutrients 2021. link 28 Ramírez-Sánchez AD, Tan IL, Gonera-de Jong BC, Visschedijk MC, Jonkers I, Withoff S. Molecular Biomarkers for Celiac Disease: Past, Present and Future. International journal of molecular sciences 2020. link 29 Cappell K, Taylor A, Johnson BH, Gelwicks S, Wang S, Gerber M et al.. Healthcare Resource Utilization and Costs in Celiac Disease: A US Claims Analysis. The American journal of gastroenterology 2020. link 30 Reilly NR, Hammer ML, Ludvigsson JF, Green PH. Frequency and Predictors of Successful Transition of Care for Young Adults With Childhood Celiac Disease. Journal of pediatric gastroenterology and nutrition 2020. link 31 Brown NK, Guandalini S, Semrad C, Kupfer SS. A Clinician's Guide to Celiac Disease HLA Genetics. The American journal of gastroenterology 2019. link 32 Paul SP, Adams HL, Basude D. Interpretation and implementation of the revised European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines on pediatric celiac disease amongst consultant general pediatricians in Southwest of England. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 2019. link 33 Potter K, de Koning L, Butzner JD, Gidrewicz D. Survey of the initial management of celiac disease antibody tests by ordering physicians. BMC pediatrics 2019. link 34 Stojanović B, Kočović A, Radlović N, Leković Z, Prokić D, Đonović N et al.. Assessment of Quality of Life, Anxiety and Depressive Symptoms in Serbian Children with Celiac Disease and their Parents. Indian journal of pediatrics 2019. link 35 Baroudi M, Petersen S, Namatovu F, Carlsson A, Ivarsson A, Norström F. Preteen children's health related quality of life in Sweden: changes over time and disparities between different sociodemographic groups. BMC public health 2019. link 36 Poddighe D, Rakhimzhanova M, Marchenko Y, Catassi C. Pediatric Celiac Disease in Central and East Asia: Current Knowledge and Prevalence. Medicina (Kaunas, Lithuania) 2019. link 37 Kikut J, Konecka N, Szczuko M. Quantitative assessment of nutrition and nutritional status of patients with celiac disease aged 13–18. Roczniki Panstwowego Zakladu Higieny 2019. link 38 Bishop J, Reed P, Austin P, Hurst M, Ameratunga R, Craigie A et al.. Prospective Evaluation of the ESPGHAN Guidelines for Diagnosis of Celiac Disease in New Zealand Children. Journal of pediatric gastroenterology and nutrition 2018. link 39 Robert ME, Crowe SE, Burgart L, Yantiss RK, Lebwohl B, Greenson JK et al.. Statement on Best Practices in the Use of Pathology as a Diagnostic Tool for Celiac Disease: A Guide for Clinicians and Pathologists. The American journal of surgical pathology 2018. link 40 Kiseleva EP, Mikhailopulo KI, Zdorovenko EL, Knirel YA, Novik GI. Linear α-(1 → 6)-d-glucan from Bifidobacterium bifidum BIM В-733D is low molecular mass biopolymer with unique immunochemical properties. Carbohydrate research 2018. link 41 Hammami S, Aref HL, Khalfa M, Kochtalli I, Hammami M. Refeeding syndrome in adults with celiac crisis: a case report. Journal of medical case reports 2018. link 42 Lee GJ, Kao JY. Recent advances in pediatric celiac disease. Expert review of gastroenterology & hepatology 2017. link 43 Efthymakis K, Serio M, Milano A, Laterza F, Bonitatibus A, Di Nicola M et al.. Application of the Biopsy-Sparing ESPGHAN Guidelines for Celiac Disease Diagnosis in Adults: A Real-Life Study. Digestive diseases and sciences 2017. link 44 Sergi C, Shen F, Bouma G. Intraepithelial lymphocytes, scores, mimickers and challenges in diagnosing gluten-sensitive enteropathy (celiac disease). World journal of gastroenterology 2017. link 45 Deora V, Aylward N, Sokoro A, El-Matary W. Serum Vitamins and Minerals at Diagnosis and Follow-up in Children With Celiac Disease. Journal of pediatric gastroenterology and nutrition 2017. link 46 Rybicka I, Gliszczynska-Swiglo A. Gluten-Free Flours from Different Raw Materials as the Source of Vitamin B. Journal of nutritional science and vitaminology 2017. link 47 Catassi C, Fasano A. Tempters and Gluten-Free Diet. Nutrients 2016. link 48 Vici G, Belli L, Biondi M, Polzonetti V. Gluten free diet and nutrient deficiencies: A review. Clinical nutrition (Edinburgh, Scotland) 2016. link 49 Rashtak S, Khaleghi S, Marietta EV, Pittelkow MR, Larson JJ, Lahr BD et al.. Isotretinoin Exposure and Risk of Celiac Disease. PloS one 2015. link 50 Pham BN, Musset L, Chyderiotis G, Olsson NO, Fabien N. Celiac disease diagnosis: impact of guidelines on medical prescription in France. Journal of digestive diseases 2014. link 51 Ciecierega T, Dweikat I, Awar M, Shahrour M, Libdeh BA, Sultan M. Severe persistent unremitting dermatitis, chronic diarrhea and hypoalbuminemia in a child; Hartnup disease in setting of celiac disease. BMC pediatrics 2014. link 52 Master S, Lebwohl B, Ludvigsson JF, Green PH. Bibliometric study of the quality of celiac disease research publications. Journal of pediatric gastroenterology and nutrition 2013. link 53 Chumpitazi BP, Mysore K, Tsai CM, Shulman RJ. Interprovider variation of celiac disease testing in childhood chronic abdominal pain. BMC gastroenterology 2013. link 54 Collin P, Rondonotti E, Lundin KE, Spada C, Keuchel M, Kaukinen K et al.. Video capsule endoscopy in celiac disease: current clinical practice. Journal of digestive diseases 2012. link 55 Parakkal D, Du H, Semer R, Ehrenpreis ED, Guandalini S. Do gastroenterologists adhere to diagnostic and treatment guidelines for celiac disease?. Journal of clinical gastroenterology 2012. link 56 Lebwohl B, Hassid B, Ludwin S, Lewis SK, Tennyson CA, Neugut AI et al.. Increased sedation requirements during endoscopy in patients with celiac disease. Digestive diseases and sciences 2012. link 57 Shen TC, Lebwohl B, Verma H, Kumta N, Tennyson C, Lewis S et al.. Peripheral neuropathic symptoms in celiac disease and inflammatory bowel disease. Journal of clinical neuromuscular disease 2012. link 58 Cammarota G, Cesaro P, Cazzato A, Cianci R, Fedeli P, Ojetti V et al.. The water immersion technique is easy to learn for routine use during EGD for duodenal villous evaluation: a single-center 2-year experience. Journal of clinical gastroenterology 2009. link 59 Vivas S, Ruiz de Morales JG, Riestra S, Arias L, Fuentes D, Alvarez N et al.. Duodenal biopsy may be avoided when high transglutaminase antibody titers are present. World journal of gastroenterology 2009. link 60 Pinto Sánchez MI, Smecuol E, Vázquez H, Mazure R, Mauriño E, Bai JC. Very high rate of misdiagnosis of celiac disease in clinical practice. Acta gastroenterologica Latinoamericana 2009. link 61 Tully MA. Pediatric celiac disease. Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates 2008. link 62 Martin S. Against the grain: an overview of celiac disease. Journal of the American Academy of Nurse Practitioners 2008. link 63 Djuric Z, Zivic S, Katic V. Celiac disease with diffuse cutaneous vitamin K-deficiency bleeding. Advances in therapy 2007. link 64 Dickey W, McMillan SA. Increasing numbers at a specialist coeliac clinic: contribution of serological testing in primary care. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 2005. link 65 Pettersson HB, Fälth-Magnusson K, Persliden J, Scott M. Radiation risk and cost-benefit analysis of a paediatric radiology procedure: results from a national study. The British journal of radiology 2005. link 66 Boynes SG, Moore PA, Shepherd CJ, Bennett CR. Anesthetic management of a patient with celiac disease. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics 2005. link 67 Kang A, Gray J, MacGuire T, Amar J, Owen D, Yoshida E et al.. Celiac sprue and ulcerative colitis in three South Asian women. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 2004. link 68 Skoglösa J, Fälth-Magnusson K, Stenhammar L. Conscious or deep sedation: a questionnaire regarding the experience of parents, children and staff during small bowel biopsy. Acta paediatrica (Oslo, Norway : 1992) 2003. link 69 Hallert C, Grant C, Grehn S, Grännö C, Hultén S, Midhagen G et al.. Evidence of poor vitamin status in coeliac patients on a gluten-free diet for 10 years. Alimentary pharmacology & therapeutics 2002. link 70 . When is a coeliac a coeliac? Report of a working group of the United European Gastroenterology Week in Amsterdam, 2001. European journal of gastroenterology & hepatology 2001. link 71 Högberg L, Nordwall M, Stenhammar L. Small bowel capsule biopsy in children: parents' opinions on children's discomfort. Acta paediatrica (Oslo, Norway : 1992) 2001. link 72 Rumbo M, Chirdo FG, Fossati CA, Añón MC. Analysis of the effects of heat treatment on gliadin immunochemical quantification using a panel of anti-prolamin antibodies. Journal of agricultural and food chemistry 2001. link 73 Slot O, Locht H. Arthritis as presenting symptom in silent adult coeliac disease. Two cases and review of the literature. Scandinavian journal of rheumatology 2000. link 74 Schuppan D. Current concepts of celiac disease pathogenesis. Gastroenterology 2000. link 75 Mukamel M, Rosenbach Y, Zahavi I, Mimouni M, Dinari G. Celiac disease associated with systemic lupus erythematosus. Israel journal of medical sciences 1994. link 76 Peacey SR, Walls WD. Steatorrhoea and sub-total villous atrophy complicating mefenamic acid therapy. The British journal of clinical practice 1992. link 77 Coupe MO, Barnard ML, Stamp G, Hodgson HJ. Ulcerative ileojejunitis associated with pulmonary fibrosis and polymyositis. Hepato-gastroenterology 1988. link 78 Jepsen LV, Ullman S. Dermatitis herpetiformis and gluten-sensitive enteropathy in monozygotic twins. Acta dermato-venereologica 1980. link

    Original source

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      Does A Dietitian-Led Celiac Disease Clinic (DLCC) Facilitate Timely Diagnosis and Nutrition Care for Patients With Celiac Disease? — Palmer M, MacDermott P, Patel B, McIvor C, Purcell L Journal of gastroenterology and hepatology (2025)
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      Celiac disease diagnosis in clinical practice: ESPGHAN quality of care survey from 129 pediatric hospitals across 28 countries. — Litwin A, Le Thi TG, El-Lababidi N, Kindermann A, Pancheva R, Gerasimidis K et al. Journal of pediatric gastroenterology and nutrition (2025)
    3. [3]
      Pregnancy Antitissue Transglutaminase Immunoglobulin A Seropositivity and Maternal and Infant Health in the Child Health and Development Studies. — Cirillo PM, Venkatesh RD, Iscol JJ, Sangal K, Krigbaum NY, Zimmermann LM et al. The American journal of gastroenterology (2025)
    4. [4]
      Vitamin and trace elements imbalance are very common in adult patients with newly diagnosed Celiac disease. — Nuermaimaiti K, Li T, Li N, Shi T, Liu W, Abulaiti P et al. Scientific reports (2025)
    5. [5]
      Status of vitamins and minerals in children with screening-identified celiac disease: A case-control study. — Al-Hussaini A, Troncone R, Alobaid S, Bashir MS Journal of pediatric gastroenterology and nutrition (2024)
    6. [6]
      Differences in Plasma 25-Hydroxyvitamin D Levels at Diagnosis of Celiac Disease and Type 1 Diabetes. — Marino M, Galeazzi T, Gesuita R, Ricci S, Catassi C, Cherubini V et al. Nutrients (2024)
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      Prevalence of Celiac Disease in Patients With Liver Diseases: A Systematic Review and Meta-Analyses. — Yoosuf S, Singh P, Khaitan A, Strand TA, Ahuja V, Makharia GK The American journal of gastroenterology (2023)
    8. [8]
      Liver abnormalities in celiac disease and response to gluten free diet: A systematic review and meta-analysis. — Jena A, Kumar-M P, Kumar A, Birda CL, Choudhury A, Kumar N et al. Journal of gastroenterology and hepatology (2023)
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      American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease. — Rubio-Tapia A, Hill ID, Semrad C, Kelly CP, Greer KB, Limketkai BN et al. The American journal of gastroenterology (2023)
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      The Influence of SARS-CoV-2 Pandemic on the Diagnosis of Celiac Disease and Clinical Practice in Pediatric Gastroenterology. — Crocco M, Calvi A, Canzoneri F, Malerba F, Zampatti N, Chiaro A et al. Nutrients (2023)
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      Celiac Disease Presenting in a Community-Based Gastroenterology Practice: Obesity and Bone Disease Are Common. — Roldan GA, Jamot S, Kopec K, Charoen A, Leffler D, Feller ER et al. Digestive diseases and sciences (2023)
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      Nutritional assessment of women with celiac disease compared to the general population. — van Megen F, Fossli M, Skodje GI, Carlsen MH, Andersen LF, Veierød MB et al. Clinical nutrition ESPEN (2023)
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      The Importance of an Early Evaluation after Establishing a Gluten-Free Diet in Children with Celiac Disease. — Martín-Masot R, Jiménez-Muñoz M, Herrador-López M, Flor-Alemany M, Navas-López VM, Nestares T Nutrients (2023)
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      Anti-tissue transglutaminase antibodies (TG2A) positivity and the risk of vitamin D deficiency among children - a cross-sectional study in the generation R cohort. — van der Velde LA, Beth SA, Voortman T, van Zelm MC, Moll HA, Kiefte-de Jong JC BMC pediatrics (2023)
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      Celiac patient satisfaction with nursing consultations in a gastroenterology department. — Martinez Santos Y, Camo Monterde P, Badía Martínez M, Espina Cadena S Revista espanola de enfermedades digestivas (2022)
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      Micronutrient deficiencies are frequent in adult patients with and without celiac disease on a gluten-free diet, regardless of duration and adherence to the diet. — Jivraj A, Hutchinson JM, Ching E, Marwaha A, Verdu EF, Armstrong D et al. Nutrition (Burbank, Los Angeles County, Calif.) (2022)
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      Long-Term Effect of Gluten-Free Diets on Nutritional Status, Body Composition, and Associated Factors in Adult Saudi Females with Celiac Disease. — Alhosain AI, Alshammari GM, Almoteri BL, Mohammed MA, Binobead MA, Yahya MA Nutrients (2022)
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      Celiac disease poses significant risk in developing depression, anxiety, headache, epilepsy, panic disorder, dysthymia: A meta-analysis. — Sharma N, Singh K, Senapati S Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology (2021)
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      Celiac Disease Management in the United Kingdom Specialist Pediatric Gastroenterology Centers-A Service Survey. — Paul SP, Balakumar V, Gillett PM Journal of pediatric gastroenterology and nutrition (2021)
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      Best practices of handling, processing, and interpretation of small intestinal biopsies for the diagnosis and management of celiac disease: A joint consensus of Indian association of pathologists and microbiologists and Indian society of gastroenterology. — Das P, Vaiphei K, Amarapurkar AD, Sakhuja P, Nada R, Paulose RR et al. Indian journal of pathology & microbiology (2021)
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