Score-based diagnostic approach to celiac disease and bone mineral density

Area of Science:

• Pediatric Gastroenterology
• Immunology
• Radiology

Background:

• Celiac disease (CD) diagnosis relies on established guidelines.
• The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) proposed a score-based diagnostic approach (SBDA).
• The role of bone mineral density (BMD) in SBDA for CD diagnosis requires further assessment.

Purpose of the Study:

• To evaluate the performance of the ESPGHAN 2012 SBDA for diagnosing celiac disease in children.
• To determine the utility of bone mineral density (BMD) Z scores within the SBDA framework.
• To explore alternative diagnostic scenarios for celiac disease using BMD.

Main Methods:

• Calculated SBDA scores for 153 biopsy-proven celiac disease patients.
• Investigated BMD Z scores at diagnosis for children.
• Assessed SBDA sensitivity in various scenarios, including those incorporating low BMD as a diagnostic finding.

Main Results:

• All 153 children met the minimum SBDA score (≥4) for celiac disease diagnosis.
• A significant proportion (73.9%) of 142 children had low BMD Z scores (below -2).
• Excluding human leukocyte antigen (HLA) and histology, sensitivity reached 85.2%; including low BMD as malabsorption equivalent improved sensitivity to 97.2% (P = 0.001).

Conclusions:

• Score-based diagnostic approach (SBDA) showed limited success in specific scenarios.
• Low BMD, when considered an equivalent of malabsorption, significantly enhances diagnostic sensitivity for celiac disease.
• BMD measurement is a valuable objective finding, particularly when HLA and biopsy are not feasible.