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Diagnosis of coeliac disease in children younger than 2 years
Zrinjka Mišak1, Iva Hojsak, Oleg Jadrešin
1Referral Centre for Paediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia. zrinjka.misak@gmail.com
Insights
Diagnosing coeliac disease in young children may be simplified. One small intestinal biopsy with positive serology can confirm coeliac disease, avoiding further biopsies and gluten challenges in some cases.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Digestive Diseases
Background:
- Traditional coeliac disease (CD) diagnosis in children under 2 involved three small bowel biopsies.
- Recent guidelines explored simplifying this diagnostic process.
Purpose of the Study:
- To evaluate the effectiveness of a single small intestinal biopsy combined with positive serology for diagnosing CD in children under 2 years.
- To determine if this approach could replace the older, multi-biopsy criteria.
Main Methods:
- A prospective cohort study of 81 children under 2 years with suspected CD.
- All participants underwent three small bowel biopsies and a gluten challenge.
- Patients were categorized into confirmed CD (Group A) and non-confirmed CD (Group B) based on the third biopsy and gluten challenge outcomes.
Main Results:
- Marsh IIIc villous atrophy was significantly more prevalent in confirmed CD cases (77% vs. 27%, P < 0.01).
- Positive serological markers, including anti-endomysial antibodies, were also significantly higher in the confirmed CD group (P < 0.01).
- Positive anti-endomysial antibodies and Marsh IIIc findings were strong predictors differentiating confirmed CD from non-confirmed cases.
Conclusions:
- Diagnosing coeliac disease in children under 2 may be achieved with one biopsy and positive serology (anti-endomysial antibodies and Marsh IIIc).
- This approach could potentially eliminate the need for repeat biopsies and gluten challenges in select pediatric patients.
- A gluten challenge remains essential for children not meeting these specific diagnostic criteria.
Background And Aim:
To diagnose coeliac disease (CD) in children younger than 2 years, the old ESPGHAN criteria based on 3 small bowel biopsies were recommended until recently. The aim of the present study was to investigate the applicability of only 1 small intestinal biopsy plus positive serology for the diagnosis of CD in children younger than 2 years.
Methods:
A prospective cohort study included 81 patients younger than 2 years with symptoms suggestive of CD, who all completed the diagnostic procedure based on 3 small bowel biopsies. According to the finding of the third biopsy, patients were divided into group A-CD confirmed (N = 44), and group B-CD not confirmed, after the gluten challenge (N = 37).
Results:
At the time of the first biopsy, total villous atrophy (Marsh IIIc) was found more often in group A than in group B (77% vs 27%, P < 0.01). Also, all of the studied antibodies were more frequently positive in group A than in group B (P < 0.01 for all of the tested antibodies). Positive anti-endomysial antibodies and Marsh IIIc finding were the best discriminators between the group A and the group B and considerably contributed to the prediction of CD.
Conclusions:
The second and the third biopsies (before and after the gluten challenge) may also be avoided when diagnosing CD in children younger than 2 years provided that the child, at the time of presentation, has positive anti-endomysial antibodies and Marsh IIIc on the small bowel biopsy. A gluten challenge should be still considered in all other children younger than 2 years.
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