The diagnosis of celiac disease is entering a new phase. At the center of the scientific debate, which emerged during the congress of the Italian Society of Gastroenterology and Digestive Endoscopy, is the introduction of the “biopsy-free” approach, which in many cases could eliminate the need for intestinal sampling even in adults. According to the experts gathered in Rome as part of the FISMAD National Congress of Digestive Diseases 2026, the diagnosis could be increasingly based on highly reliable serological markers, changing a protocol that has remained unchanged for decades.
The role of antibodies and the scientific breakthrough
Professor Fabiana Zingone, of the University of Padua, explains that levels of anti-transglutaminase IgA antibodies higher than ten times the norm show a high predictive capacity of the disease. In these selected cases, the biopsy may no longer be necessary, reducing invasiveness and diagnostic times. The new European guidelines of 2025 officially open this possibility for patients under 45 years of age, without alarm symptoms and followed in specialized centers, as long as the positivity is confirmed in a second blood sample.
New biomarkers and personalized medicine
Research is pushing beyond traditional diagnosis alone. Among the most promising innovations is the role of interleukin-2 (IL-2), a biomarker capable of signaling the immune response to gluten already in the initial stages. This could improve both diagnosis without biopsy and the management of patients already on a gluten-free diet, helping to understand the minimum threshold for disease activation.
Screening and “diagnostic iceberg” still submerged
In Italy, official diagnoses are approaching 280 thousand cases, but over half of the patients still remain unidentified. For this reason, a national screening combined with type 1 diabetes is taking shape, provided for by law 130, already tested in some pilot regions and now expanding on a national scale. The aim is to bring out the so-called “celiac disease iceberg”, still largely invisible.
Future therapies and disease management
A gluten-free diet remains the only treatment, but about one in five patients continues to have symptoms. For this reason, research is developing drugs capable of modulating the immune response, acting on enzymes and cytokines involved in inflammation. According to experts, these therapies will not replace the diet but could become a fundamental support in more complex cases.
On an institutional level, Italy is also aiming for simplification: digital vouchers for gluten-free foods and communication funds have already been introduced. The objective is to make access to diagnosis and treatment uniform, reducing territorial inequalities and improving the quality of life of patients.
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