Background Coeliac Disease (CD) is an immune-mediated systemic disorder elicited by gluten and related prolamines in genetically susceptible individuals.1 The diagnosis of CD depends on gluten dependant symptoms; CD-specific antibodies – against TG2, endomysial antibodies (EMA), and deamidated forms of gliadin peptides (DGP); the presence of HLA-DQ2/HLA-DQ8 and characteristic histological changes in duodenal biopsy. ESPGHAN guidelines suggest histological assessment may be omitted where clinical symptoms may be attributed to CD in addition to a high IgA anti-tTG levels (>10 times the upper limits of normal for the reference laboratory), verified by EMA positivity and HLA DQ2/DQ8 positivity.1
Aim Review the possible impact of ESPGHAN guidelines on the number of patients requiring histological assessment for CD.
Methods 3 year retrospective review of serology and histology of children screened for CD.
Results January 2009 – January 2012, 729 children screened. 32 positve with normal IgA levels.
Conclusion All but 1 patient with high anti-tTG levels (>10 X) had characteristic histological changes. Anti-tTG levels <10 X normal range in all samples from January 2010 – 2012 and 68% of all positive samples. Our results suggest that in most cases histological assessment will continue to play an important role in the diagnosis of CD. A multicentre prospective study on CD is currently underway.
Husby et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Coeliac Disease. J Pediatr Gastroenterol Nutr 2012; 54 (1):136–160