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[Diagnosis of celiac disease in clinical practice: present and future]
Elena Crehuá-Gaudiza1, Ana Barrés Fernández1, Carmen Jovaní Casano2
1Sección Gastroenterología y Nutrición Pediátrica, Hospital Clínico Universitario, Valencia, España.
Insights
European guidelines for diagnosing celiac disease (CD) were reviewed. The 2020 criteria allow more pediatric patients to be diagnosed without intestinal biopsy, improving diagnostic accessibility.
Area of Science:
- Pediatric Gastroenterology
- Autoimmune Diseases
- Diagnostic Criteria
Background:
- Updated European guidelines for celiac disease (CD) diagnosis were released in 2020.
- The study evaluated adherence to the 2012 European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) criteria.
- It also assessed the impact of the new 2020 criteria on pediatric CD diagnosis.
Purpose of the Study:
- To review compliance with the 2012 ESPGHAN diagnostic criteria for celiac disease.
- To describe clinical characteristics of pediatric patients diagnosed with CD.
- To evaluate the implications of the 2020 ESPGHAN criteria on diagnostic practices.
Main Methods:
- A retrospective multicenter study involving 10 centers.
- Included 163 pediatric patients (0-16 years) with new CD diagnoses in 2018-2019.
- Collected data on clinical presentation, serology, and intestinal biopsy (IB) performance.
Main Results:
- 47.9% of patients met criteria for no IB under 2012 guidelines, but 17.8% of indicated biopsies were not performed.
- IB performance varied by hospital type, being lower in secondary centers.
- Applying 2020 criteria (excluding HLA) would reduce IB need to 60.7% of patients.
Conclusions:
- Observed discrepancies in applying 2012 ESPGHAN criteria due to variable access to EMA and IB.
- The 2020 ESPGHAN criteria simplify diagnosis, potentially allowing ~60% of pediatric celiac disease patients to be diagnosed without IB.
- Ensuring access to EMA testing is crucial for the effective implementation of the 2020 criteria.
Introduction:
European guidelines for the diagnosis of celiac disease (CD) have been updated in 2020. The primary objective was to review the compliance with the diagnostic criteria for CD, according to ESPGHAN 2012. Secondarily, to describe the clinical characteristics of the patients and to assess the changes that would be implied by the application of the new 2020 criteria.
Patients And Methods:
Retrospective multicenter study in which 10 centers participated. Patients from 0 to 16 years old with a new diagnosis of CD in 2018-2019 were included. Clinical, serological variables and the performance of intestinal biopsy (IB) were collected.
Results:
163 patients were included (57% female) with a median age of 7.6 years (SD 4.4). The form of presentation was: 47.8% classical, 30.7% no classical and 21.5% asymptomatic, with differences depending on age. Total IgA and anti-transglutaminase IgA antibodies were performed in all centers as the first diagnostic step. IgA anti-endomysial antibodies (EMA) were performed in 80%, and HLA haplotype in 95%. Of the total, 78 cases (47.9%) met criteria for not performing intestinal biopsy (IB). IB was indicated in the remaining 85 patients, but was not performed in 29 cases (17.8%). The performance of IB was lower in the secondary hospitals than in the tertiary ones (p < 0.05). If we applied the ESPGHAN 2020 criteria, we would disregard the HLA study, and 21 more patients would not have required IB (going from 47.9% to 60.7% of the total).
Conclusions:
Discrepancies are observed in the application of the ESPGHAN 2012 diagnostic criteria due to the different accessibility to EMA and endoscopic IB in secondary centers. With the ESPGHAN-2020 criteria, around 60% of patients will be able to be diagnosed without IB, provided that the determination of EMA is ensured.
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