Related Experiment Video
Updated: Feb 22, 2026
A High-Throughput Multiplexed Screening for Type 1 Diabetes, Celiac Diseases, and COVID-19
Published on: July 5, 2022
Evidence Supporting Serology-based Pathway for Diagnosing Celiac Disease in Asymptomatic Children From High-risk
Siba Prosad Paul1,2, Bhupinder Kaur Sandhu2,3, Christine Helen Spray2
1Department of Pediatrics, Torbay Hospital, Torquay.
Insights
The European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines for diagnosing celiac disease (CD) can be reliably applied to asymptomatic children from high-risk groups. This serology-based approach, using anti-tissue transglutaminase antibody (anti-tTG) titers, is cost-beneficial and supports extending current diagnostic pathways.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Genetics
Background:
- The European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) updated celiac disease (CD) diagnostic guidelines in 2012.
- Current guidelines allow serology-based CD diagnosis in symptomatic children with high anti-tissue transglutaminase antibody (anti-tTG) titers (>10× ULN), positive anti-endomysial antibody, and specific HLA types.
Purpose of the Study:
- To evaluate the reliability of the ESPGHAN serology-based diagnostic pathway for asymptomatic children in high-risk groups.
- To determine if the current guidelines can be extended to a broader pediatric population for celiac disease diagnosis.
Main Methods:
- Prospective data collection on anti-tTG titers, age, sex, and screening reasons in asymptomatic children diagnosed with CD from March 2007 to February 2017.
- Analysis of the correlation between modified Marsh-Oberhuber histological grading and anti-tTG titers.
Main Results:
- 157 asymptomatic children were diagnosed with CD; 53.5% (84/157) had anti-tTG >10× ULN.
- All 75 asymptomatic children from high-risk groups with anti-tTG >10× ULN showed histology-proven CD (Marsh-Oberhuber 3a-3c).
- Serology-based diagnosis was found to be cost-beneficial, saving approximately £1275 per child in the UK.
Conclusions:
- The serology-based diagnostic pathway is effective for asymptomatic children from high-risk groups.
- The study supports extending the ESPGHAN guidelines for CD diagnosis to include these children.
- This approach offers a reliable and cost-effective method for diagnosing celiac disease in at-risk pediatric populations.
Objective:
The European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines for diagnosing celiac disease (CD) in children were modified in 2012. They recommend that in symptomatic children with anti-tissue transglutaminase antibody (anti-tTG) titer of >10 times upper limit of normal (>10× ULN) and who have positive anti-endomysial antibody and HLA-DQ2/DQ8 haplotype, the diagnosis of CD can be based on serology. The aim of this study is to establish whether serology-based pathway of the ESPGHAN guidelines could also be reliably applied to asymptomatic children from high-risk groups.
Methods:
From March 2007 to February 2017, prospective data on anti-tTG titer, age, sex, and reason for screening were collected at diagnostic endoscopy on all asymptomatic children being diagnosed as having CD. The relationship between modified Marsh-Oberhuber classification histological grading and contemporaneous anti-tTG titers was analyzed.
Results:
A total of 157 asymptomatic children were diagnosed as having CD. Eighty-four of 157 (53.5%) had antitTG >10× ULN (normal <10 IU/mL) and 75 of 84 were from high-risk groups. All 75 had definitive histological evidence (Marsh-Oberhuber 3a-3c) of small bowel enteropathy. Fifty-three of 84 children had anti-tTG >200 IU/mL and total villous atrophy was present in 29 of 53 (55%). Main reasons for serological screening were: type-1 diabetes mellitus (n = 36) and first-degree relatives with CD (n = 24). Mean age at diagnosis was 8.8 years. Serology-based diagnosis is cost-beneficial by around £1275 per child in the United Kingdom.
Conclusions:
All 75 asymptomatic children from high-risk groups with anti-tTG >10× ULN had histology-proven CD. This study provides further evidence that the guidelines for diagnosing CD by the serology-based pathway should be extended to these children.
More Related Videos
06:50A High-Throughput Electrochemiluminescence 7-Plex Assay Simultaneously Screening for Type 1 Diabetes and Multiple Autoimmune Diseases
Published on: May 29, 2020
10:27Recognition of Epidermal Transglutaminase by IgA and Tissue Transglutaminase 2 Antibodies in a Rare Case of Rhesus Dermatitis
Published on: December 15, 2011
Related Concept Videos
01:30Serum Laboratory Studies, Stool Test, Breath Test
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...