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In 2012, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) revised diagnostic guidance for paediatric coeliac disease (CD).1 It recommended a no-biopsy pathway (NBP) for symptomatic children if so-called ‘triple test’ criteria are satisfied1:
IgA anti-tissue transglutaminase antibodies (anti-tTGA) titre >10 times upper-limit-of-normal (10×ULN) and are IgA sufficient.
Positive IgA anti-endomysial antibodies (EMA).
Positive HLA-DQ2/DQ8 haplotype.
The British Society of Paediatric Gastroenterology, Hepatology and Nutrition adopted the guidelines in 2013. ESPGHAN suggested that CD can only be diagnosed by paediatric gastroenterologists or consultant paediatricians with special interest (SPIN) in gastroenterology.1 Many secondary care centres (SCC) in the UK have no SPIN consultant, therefore CD diagnosis is often made by (non-SPIN) general paediatricians.
The NBP was implemented in Southwest England (SWE) in May 2013.2 An electronic register is maintained in …
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