Joint BSPGHAN and Coeliac UK guidelines for the diagnosis and management of coeliac disease in children

Abstract

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.

Coeliac disease in children – an update for general dental practitioners

“…The ESPGHAN guidelines for diagnosing CD in children recommend that in symptomatic children with tTGtitres of >10 times of the upper limit of normal (>10xULN), CD can be diagnosed without need for small bowel biopsies provided they have a positive HLA-DQ2/DQ8 haplotype and a positive anti-endomysial antibody (EMA) result 1,2 . Small bowel biopsies are still required in all other cases as highlighted below while the child remains on a normal non-restrictive gluten containing diet [initiation of GFD leads to recovery of intestinal mucosa resulting in negative small bowel biopsies] 1,2,7 :…”

“…Longterm risks include osteoporosis and low bone mineral density, increased risk of pathological fractures, bowel cancer, unfavourable pregnancy outcomes, low birth weight in offspring, spontaneous abortion and development of other autoimmune conditions 2,7 .…”

“…CD is characterised by the presence of a variable combination of gluten dependent clinical manifestations, specific antibodies, human leucocyte antigen HLA-DQ2 or HLA-DQ8 haplotypes and enteropathy' 1,2 . Children commonly present with gastrointestinal features such as abdominal pain, bloating, persistent diarrhoea, and weight loss although increasingly extra-intestinal features are being recognised 2 .…”

Diagnosis of coeliac disease in children in primary care and clinical implications

“…These guidelines have been reviewed by the coeliac working group of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) together with Coeliac UK, who have jointly published recommendations for coeliac disease diagnosis and management for UK paediatric practice. 10 This does not encompass non-coeliac wheat intolerance.…”

Re: HLA is better than serological screening for celiac diseases in rheumatological arthritis

“…Regarding to the guidelines produced by ESPGHAN, modified by BSPGHAN, HLA typing could be done in 'high risk' populations to rule out celiac disease (CD) (5,6). We believe submitted comment requires that patients with rheumatologic diseases consider as high risk population for CD.…”