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Omitting control biopsy in paediatric coeliac disease: a follow-up study
Anna Killander1, Henrik Arnell, Lars Hagenäs
1Department of Women and Child Health, Karolinska Institutet, Stockholm Sweden. anna.killander@karolinska.se
Insights
Diagnosing coeliac disease in children may not require a second biopsy. This study found that one biopsy was sufficient for diagnosis, with most children showing improved growth and symptom resolution on a gluten-free diet.
Area of Science:
- Pediatric Gastroenterology
- Immunology
Background:
- Coeliac disease diagnosis typically involves small-bowel biopsies.
- The necessity of a second biopsy for confirmation is debated.
Purpose of the Study:
- To assess the diagnostic accuracy of using a single small-bowel mucosal biopsy for coeliac disease in children.
- To evaluate the clinical outcomes in children diagnosed with coeliac disease using a single biopsy.
Main Methods:
- Retrospective review of 102 children diagnosed with coeliac disease.
- Inclusion criteria: age >18 months, elevated serum antitissue transglutaminase IgA, and a positive biopsy.
- Follow-up included anthropometric data and symptom assessment after 1 year on a gluten-free diet.
Main Results:
- 98% of children exhibited normal or catch-up growth after one year.
- Symptom regression was reported in 98% of children on a gluten-free diet.
- Serum antitissue transglutaminase IgA levels normalized or remained slightly elevated in most children after one year.
Conclusions:
- A single small-bowel mucosal biopsy is sufficient for diagnosing coeliac disease in selected children.
- Routine follow-up biopsy may not be necessary, simplifying the diagnostic process.
Aim:
To evaluate the practice of diagnosing coeliac disease with only one small-bowel mucosal biopsy in a selected group of children with suspected coeliac disease.
Methods:
A retrospective review of medical records and a follow-up interview of 102 children (65 girls, 37 boys) at diagnosis of coeliac disease. The inclusion criteria were age >18 months, increased levels of serum antitissue transglutaminase IgA antibodies and pathologic small-bowel mucosal biopsy. Anthropometric data were calculated for children 1.5-11 years of age.
Results:
The levels of serum antitissue transglutaminase IgA antibodies were either normal (92%) or slightly elevated (8%) in all children after 1 year on a gluten-free diet. The height-for-age Z score increased in 52 of 61 (85%) children, (median 0.26 SD, range -0.45 to 1.83 SD) and the weight-for-age Z score increased in 50 of 61 (82%) children (median 0.42 SD, range -0.77 to 2.24 SD). Sixty of 61 (98%) children showed normal or catch-up growth. Regression of symptoms after 1 year on a gluten-free diet was reported for 71 of 72 (98%) children.
Conclusion:
We propose that a control biopsy is not necessary for the diagnosis of coeliac disease in these children.
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