ESPGHAN 2012 Guidelines for Coeliac Disease Diagnosis

Donat, Ester; Ramos, José Manuel; Sánchez-Valverde, F.; Moreno, A.; Martinez, Maria-Jose; Leis, Rosaura; Quintana, Luis Peña; Castillejo, Gemma; Fernández, Sonia Fernández; García, Z. Valera; Ortigosa, Luís; Balmaseda, Elena; Marugán, José-Manuel; Eizaguirre, Francisco-Javier; Lorenzo, Helena; Barrio, Josefa; Ribes-Koninckx, Carmen

doi:10.1097/mpg.0000000000000870

Cited by 32 publications

(11 citation statements)

References 26 publications

(32 reference statements)

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“…The use of the EMA-test as a confirmatory diagnostic test has been reinforced by the updated ESPGHAN guidelines of 2020, so an increase in its implementation may be expected in the future, particularly in children diagnosed without biopsies [ 19 ]. The significant reduction (46.3%) of diagnostic biopsies in our country, which is in accordance with findings from other studies [ 16 , 20 ], indicates that the implementation of the non-biopsy strategy has taken place quickly and efficiently. However, the guidelines for non-biopsy diagnosis in children have not yet been adopted in all countries, despite its numerous advantages such as the reduction in medical costs and avoidance of general anaesthesia or deep sedation [ 21 , 22 ].…”

Section: Discussionsupporting

confidence: 92%

Efficient implementation of the ‘non-biopsy approach’ for the diagnosis of childhood celiac disease in the Netherlands: a national prospective evaluation 2010–2013

et al. 2021

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The aim of this study was (1) to prospectively evaluate the nationwide implementation of the ESPGHAN-guidelines for the diagnosis of celiac disease (CD), (2) to investigate the incidence and clinical presentation of diagnosed childhood CD (0–14 years) in the Netherlands, and (3) to compare the findings with national survey data from 1975 to 1990 and 1993 to 2000 using the same approach. From 2010 to 2013, all practicing paediatricians were invited to report new celiac diagnoses to the Dutch Pediatric Surveillance Unit. Data were collected via questionnaires. A total of 1107 children with newly diagnosed CD were reported (mean age, 5.8 years; range, 10 months–14.9 years; 60.5% female). After the introduction of the non-biopsy approach in 2012, 75% of the diagnoses were made according to the guideline with a significant decrease of 46.3% in biopsies. The use of EMA and HLA-typing significantly increased with 25.8% and 62.1%, respectively. The overall incidence rate of childhood CD was 8.8-fold higher than in 1975–1990 and 2.0-fold higher than in 1993–2000. During the study period, the prevalence of diagnosed CD was 0.14%, far below 0.7% of CD identified via screening in the general Dutch paediatric population. Clinical presentation has shifted towards less severe and extra-intestinal symptoms.Conclusion: ESPGHAN guidelines for CD diagnosis in children were effectively and rapidly implemented in the Netherlands. Incidence of diagnosed CD among children is still significantly rising with a continuous changing clinical presentation. Despite the increasing incidence of diagnoses, significant underdiagnosis still remains. What is Known:• Since 2000 the incidence of diagnosed childhood CD in the Netherlands has shown a steady rise.• The rise in incidence has been accompanied by a changing clinical presentation at diagnosis. What is New:• The ESPGHAN guidelines 2012 for CD diagnosis were effectively and rapidly implemented in the Netherlands.• The incidence of diagnosed childhood CD in the Netherlands has continued to rise significantly during the reported period.

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Section: Discussionsupporting

confidence: 92%

Efficient implementation of the ‘non-biopsy approach’ for the diagnosis of childhood celiac disease in the Netherlands: a national prospective evaluation 2010–2013

et al. 2021

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“…The 2 crosssectional studies were mass-screening studies in the general population, not seeking medical attention for any complaint or risk (36,37). The 3 retrospective studies included patients who were at risk of CD (29,38,39). As studies with a large number of CD cases with coexisting type 1 diabetes have not been included in our literature search, this specific group of patients has not been addressed in this question.…”

Section: Antibodiesmentioning

confidence: 99%

European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020

Husby

Koletzko

Korponay-Szabó

et al. 2020

J. pediatr. gastroenterol. nutr.

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738

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Objectives: The ESPGHAN 2012 coeliac disease (CD) diagnostic guidelines aimed to guide physicians in accurately diagnosing CD and permit omission of duodenal biopsies in selected cases. Here, an updated and expanded evidence-based guideline is presented. Methods: Literature databases and other sources of information were searched for studies that could inform on 10 formulated questions on symptoms, serology, human leukocyte antigen genetics, and histopathology. Eligible articles were assessed using QUADAS2. GRADE provided a basis for statements and recommendations. Results: Various symptoms are suggested for case finding, with limited contribution to diagnostic accuracy. If CD is suspected, measurement of total serum IgA and IgA-antibodies against transglutaminase 2 (TGA-IgA) is superior to other combinations. We recommend against deamidated gliadin peptide antibodies (DGP-IgG/IgA) for initial testing. Only if total IgA is low/undetectable, an IgG-based test is indicated. Patients with positive results should be referred to a paediatric gastroenterologist/specialist. If TGA-IgA is ≥10 times the upper limit of normal (10× ULN) and the family agrees, the no-biopsy diagnosis may be applied, provided endomysial antibodies (EMA-IgA) will test positive in a second blood sample. Human leukocyte antigen DQ2-/DQ8 determination and symptoms are not obligatory criteria. In children with positive TGA-IgA <10× ULN at least 4 biopsies from the distal duodenum and at least 1 from the bulb should be taken. Discordant results between TGA-IgA and histopathology may require re-evaluation of biopsies. Patients with no/mild histological changes (Marsh 0/I) but confirmed autoimmunity (TGA-IgA/EMA-IgA+) should be followed closely. Conclusions: CD diagnosis can be accurately established with or without duodenal biopsies if given recommendations are followed.

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“…Beginning with the clinical and laboratory data [ 7 , 8 ], celiac disease was diagnosed. In addition, primary AD was suspected.…”

Section: Case Presentationmentioning

confidence: 99%

Unusual Onset of Celiac Disease and Addison’s Disease in a 12-Year-Old Boy

Miconi

Savarese

Miconi

et al. 2017

IJERPH

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Background: Celiac disease (CD) is an autoimmune disorder deriving from an aberrant adaptive immune response against gluten-containing grains in genetically predisposed subjects. In a number of patients, CD is associated with one or more other autoimmune diseases. Primary Addison’s disease (AD) and CD may co-exist, although this association is relatively uncommon in children. In addition, it is not precisely defined whether a gluten-free diet influences the course of AD. Case presentation: A case of CD in a 12-year-old boy presenting as acute adrenal insufficiency is described here. A gluten-free diet had a significant therapeutic role in this case, wherein most of the clinical signs and symptoms of AD disappeared in a few days. In addition, the dosage of cortisol acetate, initially administered to treat the AD, was able to be rapidly reduced. Conclusion: This case highlights that CD can be associated with AD in children, and a gluten-free diet seems to positively influence the course of AD.

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ESPGHAN 2012 Guidelines for Coeliac Disease Diagnosis

Abstract: Our results support the new ESPGHAN 2012 guidelines for diagnosis of CD can be safely used without the risk of overdiagnosis. A prospective multicentre study is needed to confirm our results.

Cited by 32 publications

References 26 publications

Efficient implementation of the ‘non-biopsy approach’ for the diagnosis of childhood celiac disease in the Netherlands: a national prospective evaluation 2010–2013

Efficient implementation of the ‘non-biopsy approach’ for the diagnosis of childhood celiac disease in the Netherlands: a national prospective evaluation 2010–2013

European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020

Unusual Onset of Celiac Disease and Addison’s Disease in a 12-Year-Old Boy

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