Australasian Pediatric Gastroenterologists’ Perspectives and Practices of Celiac Disease Diagnosis and Management

Abstract

Background The application of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) celiac disease (CeD) guidelines by pediatric gastroenterologists in Australia and New Zealand (Australasia) is unknown. Similarly, long-term management practices for patients with CeD are also unknown in this region. Aims This study aimed to explore the perceptions and practices of Australasian pediatric gastroenterologists in diagnosing and managing patients with CeD. Methods Australasian pediatric gastroenterologists and trainees were invited to complete an anonymous online survey over a 3-week period. Results The survey was completed by 28 respondents, 24 from Australia and four from New Zealand. Tissue transglutaminase antibody IgA was the most frequently ordered initial serologic test. Fifteen (54%) respondents relied on duodenal biopsies for the confirmation of CeD, six (21%) followed the ESPGHAN guidelines and the remaining seven offered either biopsy confirmation or no-biopsy diagnosis according to the parents' wishes. Following diagnosis, five (18%) respondents discharged patients from care, three (11%) discharged patients after one follow-up visit, one (4%) reviewed patients for 12 months, six (21%) reviewed patients until celiac antibodies normalized and children were clinically asymptomatic, and 13 (46%) reviewed patients until transition to adult care. Conclusion Tissue transglutaminase antibody IgA was the most common initial serologic test ordered by this group of Australasian pediatric gastroenterologists. Half of these physicians rely solely on duodenal biopsy for the confirmation of CeD diagnosis: a minority routinely use the ESPGHAN guidelines. Physicians reported a wide range of CeD follow-up practices. Supplementary Information The online version contains supplementary material available at 10.1007/s10620-021-06988-2.

Australasian paediatric gastroenterologist practices of coeliac disease diagnosis before and during the COVID‐19 pandemic

“…5 About 54% of 28 (n = 15) respondents solely relied on biopsy confirmation for CD diagnosis, 25% (n = 7) offered either biopsy or non-biopsy confirmation according to parents' wishes and the other 21% (n = 6) routinely practised non-biopsy CD diagnosis. 8 During the coronavirus disease (COVID)-19 pandemic, elective medical procedures including endoscopy were variably affected across Australia and NZ. This study hypothesised that the COVID-19 pandemic had changed the practices of paediatric CD diagnosis by Australasian paediatric gastroenterologists.…”

“…5 An earlier survey assessed the perspectives and practices of Australian and NZ paediatric gastroenterologists regarding the diagnosis and management of CD. 8 That study was conducted towards the end of 2019 prior to the full publication of the 2020 ESPGHAN guidelines. 5 About 54% of 28 (n = 15) respondents solely relied on biopsy confirmation for CD diagnosis, 25% (n = 7) offered either biopsy or non-biopsy confirmation according to parents' wishes and the other 21% (n = 6) routinely practised non-biopsy CD diagnosis.…”

“…An earlier survey assessed the perspectives and practices of Australian and NZ paediatric gastroenterologists regarding the diagnosis and management of CD 8 . That study was conducted towards the end of 2019 prior to the full publication of the 2020 ESPGHAN guidelines 5 .…”

Abordaje de la enfermedad celiaca en pediatría

“…Sin embargo, es una enfermedad subdiagnosticada por la variedad de presentaciones clínicas que tiene, incluso se le ha descrito como "la gran simuladora", al igual que la sífilis (3). Las presentaciones clínicas en la población pediátrica son muy variadas, y pueden ir desde síntomas típicos de malabsorción intestinal hasta manifestaciones extraintestinales, o incluso pueden ser asintomáticos, siendo estas dos últimas las que representan un mayor reto diagnóstico (4,5). Al día de hoy, el único tratamiento para los pacientes con enfermedad celíaca es una dieta estricta libre de gluten de por vida, la cual revierte el daño intestinal y alivia los síntomas (4).…”

“…Las presentaciones clínicas en la población pediátrica son muy variadas, y pueden ir desde síntomas típicos de malabsorción intestinal hasta manifestaciones extraintestinales, o incluso pueden ser asintomáticos, siendo estas dos últimas las que representan un mayor reto diagnóstico (4,5). Al día de hoy, el único tratamiento para los pacientes con enfermedad celíaca es una dieta estricta libre de gluten de por vida, la cual revierte el daño intestinal y alivia los síntomas (4). Además, es importante instaurar el tratamiento lo antes posible, para prevenir complicaciones como anemia crónica, pubertad tardía, alteraciones neuropsiquiátricas, desórdenes autoinmunes asociados, infertilidad, osteoporosis, y menos comúnmente neoplasias intestinales; asimismo, puede reducir la calidad de vida de los pacientes (6).…”