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
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.