Coeliac disease in the ERA of the new ESPGHAN and BSPGHAN guidelines: a prospective cohort study

Benelli, Elisa; Carrato, Valentina; Martelossi, Stefano; Ronfani, Luca; Not, Tarcisio; Ventura, Alessandro

doi:10.1136/archdischild-2015-309259

Cited by 29 publications

(26 citation statements)

References 14 publications

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“…Even though CD can be reliably diagnosed following the latest ESPGHAN and BSPGHAN guidelines [16], as not all diagnostic procedures required by the new guidelines are available in all countries, our results may suggest to further simplify the new ESPGHAN guidelines. As a matter of fact, it is not useful nor necessary to perform an expensive determination, such as HLA, as in all patients with tTG higher than 10 x ULN who had HLA heterodimer determined it was compatible with CD.…”

Section: Discussionmentioning

confidence: 97%

Diagnosis of celiac disease and applicability of ESPGHAN guidelines in Mediterranean countries: a real life prospective study

et al. 2017

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BackgroundWe assessed how the diagnosis of Celiac Disease (CD) is made and how the new ESPGHAN guidelines can be applied in children from countries with different resources.MethodsA real life prospective study was performed in 14 centres of 13 different Mediterranean countries. Participants were asked to apply the usual diagnostic work-up for CD according to their diagnostic facilities.ResultsThere were 1974 patients enrolled in the study, mean age 4 years, 10 months; 865 male, 1109 female. CD was confirmed in 511 (25.9%) and was unconfirmed in 1391 (70.5%) patients; 14 patients were diagnosed as having CD according to the new ESPGHAN guidelines, 43 patients were classified as having potential CD. In all participating countries the diagnosis of CD relied on histology of duodenal biopsy; in 5 countries, HLA, and in one country endomysial antibodies (EMA) were not available. Symptoms did not add a significant increase to the pre-test probability of serological tests. The positive predictive value of tissue transglutaminase type 2 (tTG) antibodies performed with different kits but all corresponding to those recommended by ESPGHAN was 96.1% (95% CI 94–97.9%) in presence of tTG > 10xULN. In 135 patients with tTG >10xULN, HLA genotyping was performed and in all it was compatible with CD.ConclusionsThe results of our study show that CD diagnosis still relies on intestinal biopsy in the Mediterranean area. New ESPGHAN criteria are not applicable in 5 countries due to lack of resources needed to perform HLA genotyping and, in one country, EMA assay. Further simplification of the new ESPGHAN guidelines might be made according to what preliminarily the present results suggest if confirmed by new prospective studies.

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Section: Discussionmentioning

confidence: 97%

Diagnosis of celiac disease and applicability of ESPGHAN guidelines in Mediterranean countries: a real life prospective study

et al. 2017

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“…More recently, the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) also reviewed its diagnostic guidelines for CD, reaching similar conclusions [21]. A very recent prospective study showed that diagnosis of CD can be reliably performed without a duodenal biopsy in approximately 11% of cases, selected applying the ESPGHAN/BSPGHAN guidelines in a restricted way, considering as symptomatic only those cases with diarrhoea, weight loss, failure to thrive and iron deficiency anaemia [22]. However, some studies suggest prudence in omitting performance of a duodenal biopsy in these children.…”

Section: Discussionmentioning

confidence: 99%

Omitting duodenal biopsy in children with suspected celiac disease and extra-intestinal symptoms

et al. 2017

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BackgroundThe aim of our study is to evaluate if in children with highly positive serology and HLA-DQ2/DQ8 (triple test, TT) and only extra-intestinal symptoms, it is possible to omit performing an intestinal biopsy for celiac disease (CD) diagnosis, as suggested by the new European Society for Pediatric Gastroenterology, Hepatology and Nutrition ESPGHAN guidelines.MethodsIn this retrospective study a total of 105 patients, suspected of having CD because of extra-intestinal symptoms and showing serum tissue transglutaminase antibody (anti-tTG) and anti-endomysial antibody (EMA) measurements and HLA genotyping, were considered for the final analysis (33 boys and 72 girls; age range 1.5–17.6 years).ResultsHistological findings confirmed diagnosis of CD in 97 (92.4%) patients. Forty-one patients (39%) showed anti-tTG >10 times normal values, positive EMA and positive HLA-DQ2/DQ8 (positive TT). All of them had a diagnosis of CD, therefore there were no false positive cases. Sixty-four patients were negative for the TT. In eight cases, CD was ruled out and these were considered true negative cases. In the remaining 56 negative TT patients, intestinal biopsy confirmed CD diagnosis and they were considered false negatives. Based on these results, specificity for the TT was 100% and sensitivity was 42.3%.ConclusionsOn the basis of the present study, diagnosis of CD can be reliably performed without a duodenal biopsy in children with only extra-intestinal symptoms.

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“…Benelli et al. adopted a very strict definition of what is meant by a symptomatic patient . Only children with diarrhoea and weight loss, failure to thrive or sideropenic anaemia were classified as symptomatic.…”

Section: Discussionmentioning

confidence: 99%

Questionnaire showed that Swedish paediatric clinics complied well with the revised European guidelines for diagnosing coeliac disease

et al. 2018

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Aim In 2012, revised criteria for diagnosing childhood coeliac disease were published by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and incorporated into the revised Swedish guidelines the same year. These made it possible, in certain cases, to diagnose coeliac disease without taking small bowel biopsies. This survey assessed the extent to which the new guidelines were implemented by Swedish paediatric clinics two years after their introduction. Methods In October 2014, we distributed a paper questionnaire including five questions on diagnostic routines to the 40 paediatric clinics in university or regional hospitals in Sweden that perform small bowel biopsies. Results All 36 (90%) clinics that responded used anti‐tissue transglutaminase antibodies as the initial diagnostic test and some also used serological markers. Most clinics (81%) used endoscopy and took multiple duodenal biopsies, whereas only a few (19%) occasionally employed a suction capsule. Almost all clinics (86%) omitted taking small bowel biopsies in symptomatic children with repeatedly high coeliac serology and positive genotyping, thereby avoiding the need for invasive endoscopy under anaesthesia. Conclusion The 2012 Swedish Paediatric Coeliac Disease Diagnostic Guidelines had been widely accepted and implemented in routine health care two years after their introduction.

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Coeliac disease in the ERA of the new ESPGHAN and BSPGHAN guidelines: a prospective cohort study

Cited by 29 publications

References 14 publications

Diagnosis of celiac disease and applicability of ESPGHAN guidelines in Mediterranean countries: a real life prospective study

Diagnosis of celiac disease and applicability of ESPGHAN guidelines in Mediterranean countries: a real life prospective study

Omitting duodenal biopsy in children with suspected celiac disease and extra-intestinal symptoms

Questionnaire showed that Swedish paediatric clinics complied well with the revised European guidelines for diagnosing coeliac disease

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