Transition from childhood to adulthood in coeliac disease: the Prague consensus report

Abstract

The process of transition from childhood to adulthood is characterised by physical, mental and psychosocial development. Data on the transition and transfer of care in adolescents/young adults with coeliac disease (CD) are scarce. In this paper, 17 physicians from 10 countries (Sweden, Italy, the USA, Germany, Norway, the Netherlands, Australia, Britain, Israel and Denmark) and two representatives from patient organisations (Association of European Coeliac Societies and the US Celiac Disease Foundation) examined the literature on transition from childhood to adulthood in CD. Medline (Ovid) and EMBASE were searched between 1900 and September 2015. Evidence in retrieved reports was evaluated using the Grading of Recommendation Assessment, Development and Evaluation method. The current consensus report aims to help healthcare personnel manage CD in the adolescent and young adult and provide optimal care and transition into adult healthcare for patients with this disease. In adolescence, patients with CD should gradually assume exclusive responsibility for their care, although parental support is still important. Dietary adherence and consequences of non-adherence should be discussed during transition. In most adolescents and young adults, routine small intestinal biopsy is not needed to reconfirm a childhood diagnosis of CD based on European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) or North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) criteria, but a biopsy may be considered where paediatric diagnostic criteria have not been fulfilled, such as, in a patient without biopsy at diagnosis, additional serology (endomysium antibody) has not been performed to confirm 10-fold positivity of tissue transglutaminase antibodies or when a no biopsy strategy has been adopted in an asymptomatic child.

Current Transition Management of Adolescents and Young Adults with Allergy and Asthma: A European Survey.

“…13 The need for a multidisciplinary service model integrating social support, education and non-statutory services is well established 14 and exempli ed by the recently published European Academy of Paediatrics consensus statement. 15 Furthermore, a number of disease-speci c programmes have been set up to address the process of the transition such as in patients with chronic digestive 16 , rheumatic 17,18 , liver 8 and coeliac 19 diseases.…”

Challenges in gluten‐free diet in coeliac disease: Prague consensus

“…Last Prague consensus on coeliac disease (CD) focused on inadequate communication of the paediatrician or the paediatric gastroenterology with the adult gastroenterologist during the transition of the CD‐affected adolescent to adulthood . While diet adjustment may appear to be a straightforward intervention, adhering to a gluten‐free diet is challenging nonetheless.…”

“…However, specifically, the recommendations for the transition in CD are rare and not topic oriented . This is the reason why the Prague consensus report team should be congratulated for undertaking the task . This review focuses on the gluten‐free diet (GFD) difficulties during the transition.…”

“…In fact, up to 50% of patients with CD report consuming gluten, either intentionally or unintentionally, while on GFD resulting in persistent mucosal damage . Approximately half of the patients with CD reported dietary compliance, the European rate of compliance range being 44–97% . More so, unrecognized gluten consumption is the most commonly identified cause of nonresponsive coeliac disease .…”

No difference in emergency department visits before and after transition for coeliac disease

“…In a recent consensus document, we and others presented recommendations for the transition of care from childhood to adulthood in coeliac disease (CD) 1. Models of care transition share a goal of prevention of medical care lapses.…”