The revised BSPGHAN guidelines for the diagnosis and management of coeliac disease represent an important shift in diagnostic strategy, aimed at simplifying and shortening the diagnostic process in selected cases. Guidance is given concerning the indications for testing for coeliac disease, which is still significantly underdiagnosed in the UK. While screening data suggest a likely incidence of 1 in 100 persons, only 10%-20% of this figure is currently being diagnosed.The BSPGHAN guidelines follow the new ESPGHAN guidelines in overall diagnostic strategy, while providing more didactic stratagems, which should be of assistance for paediatricians in specialties other than gastroenterology. BSPGHAN GUIDELINEThis guideline extends the earlier BSPGHAN guideline (based on NASPGHAN Coeliac Guideline of 2005 1 and the original guideline from the Welsh Paediatric Gastroenterology MCN 2 ) to incorporate the changed ESPGHAN 2012 diagnostic guideline.3 An outline of these guidelines (figures 1 and 2) are also available to download from the BSPGHAN and Coeliac UK websites. The British Society of Gastroenterology (BSG) Coeliac Guideline for Adult Coeliac Disease, which differs in respect of biopsy stratagem, is available on the BSG website http://www.bsg.org.uk.Coeliac disease (CD) is not simply a gastrointestinal condition but an immune-mediated systemic disorder, strongly dependent on the human leukocyte antigen (HLA)-DQ2 and DQ8 haplotypes. It is elicited by gluten and related prolamines in genetically susceptible individuals and characterised by a variable combination of gluten-dependent clinical manifestations, CD-specific antibodies and enteropathy. [3][4][5][6][7] Screening studies have shown prevalence much higher than previously recognised, and there is evidence of an increased incidence of both classic and non-classic presentations in UK children.

IBD in children with disease onset before the age of 2 years is frequently unclassifiable into Crohn's disease and ulcerative colitis, particularly treatment resistant, and can be indistinguishable from monogenic diseases with IBD-like phenotype.

Coronavirus disease 2019 (COVID-19), caused by acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is predominantly a respiratory disease. However, its significant impact on the gastrointestinal (GI) system is now well-known. SARS-CoV-2 enters cells via the angiotensin-converting enzyme-2 (ACE-2) receptor, which is abundantly expressed on lung cells, but also on enterocytes. Several etiopathogenetic mechanisms have been postulated to explain the GI involvement in COVID-19, including loss in intestinal absorption, microscopic mucosal inflammation and impaired ACE-2 function, which plays a significant role in maintaining gut homeostasis. In children the GI manifestations include anorexia, nausea, vomiting, diarrhea and abdominal pain, which may represent the earliest presenting symptoms of the disease. However, although rare, a significant GI mucosal inflammation, such as terminal ileitis mimicking an atypical appendicitis, and other GI manifestations have been reported. COVID-19 pandemic has posed a significant challenge in healthcare provision in term of ability in providing safe diagnostic procedures, face-to-face consultations, and offering comprehensive care. For instance, changes in health services have raised the risk of empirical or sub-optimal management of chronic GI disorders such as inflammatory bowel disease (IBD) due to delayed endoscopic and clinical assessment. This review will discuss the acute GI involvement in COVID-19 in children and reflect on challenges and major changes observed in clinical practice during COVID-19 pandemic by sharing both the published literature and personal experience. We also suggest potential strategies for providing optimal gastroenterology care during this unprecedented era.