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Coeliac disease (CD) is a common condition with significant implications for health and future development that benefits from early identification and treatment. The interaction with other autoimmune conditions, such as type 1 diabetes mellitus (T1DM), and overlap with other more functional conditions, such as wheat sensitivity, has led clinicians to consider strategies to risk-stratify the likelihood of CD.
The European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidance1 states that CD diagnosis can be made without biopsy in patients symptomatic on a gluten-containing diet, with 1) tissue transglutaminase antibody (tTG) IgA >10× upper limit of normal, 2) positive antiendomysial antibodies and 3) HLA-DQ2 or HLA-DQ8 positivity. This strategy is to reduce the numbers (and cost) needing endoscopy and shorten the time to initiating treatment. The two additional indications for human leucocyte antigen (HLA) testing are at the time of diagnosis of an autoimmune condition and those with gut or other symptoms, whose parents initiate a wheat or gluten-free diet (GFD), with symptomatic improvement. For those with other autoimmune conditions with HLA-DQ2 or HLA-DQ8 positivity, ESPGHAN suggest tTG IgA 3 yearly based on expert opinion; for those HLA-DQ2 or HLA-DQ8 negative …
Contributors RB conceived the article. MT wrote the article, and MT and RB
edited it. RB acts as the guarantor.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.