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Misuse of serological screening tests for celiac disease in children: A prospective study in Italy
Elisa Franceschini1, Maria Elena Lionetti1, Grazia D'Adamo2
1Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy.
Insights
Pediatric celiac disease testing in Italy frequently deviates from European guidelines, with only 11.4% of cases adhering to recommendations. This highlights a need for improved adherence to optimize resource use and patient care.
Area of Science:
- Pediatric Gastroenterology
- Clinical Diagnostics
- Medical Guidelines Adherence
Background:
- Celiac disease diagnosis relies on a defined algorithm, but adherence to pediatric guidelines for serological testing remains under-evaluated.
- Current practices in prescribing celiac disease tests for children may not align with established diagnostic criteria.
Purpose of the Study:
- To assess the appropriateness of celiac disease test prescriptions in Italian children.
- To compare current testing practices against European pediatric guidelines for celiac disease diagnosis.
Main Methods:
- Prospective enrollment of children undergoing initial celiac disease evaluation.
- Recording and comparison of prescribed tests and their indications against European pediatric guidelines.
Main Results:
- 202 children were studied; 46.5% presented with typical symptoms, 49% with atypical symptoms, and 4.5% with associated conditions.
- High rates of test redundancy were observed, with guidelines correctly followed in only 11.4% of cases.
- Various serological markers (anti-transglutaminase, anti-deamidated gliadin peptide, anti-endomysium antibodies) and HLA testing were frequently prescribed, often in combination.
Conclusions:
- European guidelines for celiac disease screening are frequently not followed in Italy.
- Interventions are necessary to improve adherence to guidelines, enhancing resource management and pediatric patient care quality.
Background:
Despite a well-established diagnostic algorithm for celiac disease, it remains unclear whether prescriptions for celiac serological tests comply with the current pediatric guidelines.
Aim:
To analyze the appropriateness of test prescription in children investigated for celiac disease in Italy, compared to the current European pediatric guidelines.
Methods:
All children who had performed a first evaluation for celiac disease were prospectively enrolled. Prescribed tests and related indications for testing were recorded, and compared to the European pediatric guidelines.
Results:
Overall, 202 children were enrolled (females 59%, mean age 7.1 years ±4.1) in two centers. The reasons for celiac disease testing were typical, atypical symptoms or celiac disease-associated conditions in 46.5%, 49%, and 4.5% of cases, respectively. First-line tests were IgA and IgG anti-transglutaminase antibodies in 88.1% and 29.7% of children, IgA and IgG anti-deamidated gliadin peptide antibodies in 43% and 47%, IgA and IgG anti native gliadin in 15.8%, IgA anti-endomysium antibodies in 44.5%, HLA predisposing genes in 10% of patients. Test redundancy was very common, and the current diagnostic guidelines were correctly followed only in 23/202 patients (11.4%).
Conclusions:
Diagnostic European guidelines for celiac disease screening are often disregarded in Italy. Intervention to implement adherence to these guidelines is needed, with the aim of improving resource utilization, and quality of patient care.
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