IMPROVED ADHERENCE TO THE ESPGHAN GUIDELINES IS NECESSARY FOR DIAGNOSING CELIAC DISEASE IN CHILDREN: A SINGLE-CENTER
Wing-Yu Siobhan Lau1,2, Paul Anthony Heaton1, Siba Prosad Paul1
1Yeovil District Hospital, Department of Pediatrics, Higher Kingston, Yeovil, BA21 4AT, UK.
Insights
Adherence to European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) 2012 guidelines for diagnosing celiac disease (CD) was suboptimal in this study. Educational sessions and revised guidelines may improve diagnostic pathway adherence for pediatric CD.
Area of Science:
- Pediatric Gastroenterology
- Immunology
Background:
- Celiac disease (CD) is an immune-mediated disorder triggered by gluten ingestion.
- The 2012 European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines introduced a no-biopsy pathway (NBP) for specific pediatric cases.
Purpose of the Study:
- To evaluate adherence to the 2012 ESPGHAN guidelines for diagnosing celiac disease in a pediatric unit.
- To assess the diagnostic pathways utilized for children with positive IgA tissue transglutaminase (TGA-IgA) tests.
Main Methods:
- Retrospective review of 43 pediatric cases with positive TGA-IgA from January 2013 to December 2019.
- Analysis of diagnostic pathways and comparison with ESPGHAN 2012 guidelines for adherence.
- Exclusion of 6 patients not referred for CD diagnosis confirmation.
Main Results:
- 35 children were diagnosed with CD, with 83% (29/35) diagnosed via the NBP.
- 52% (15/29) of NBP cases did not fully meet the 2012 guideline criteria.
- Only 57% (20/35) of diagnosed CD cases adhered strictly to the 2012 guidelines.
Conclusions:
- Frequent non-adherence to the 2012 ESPGHAN diagnostic guidelines for celiac disease was observed.
- Regular education and updated guidelines (e.g., 2020 ESPGHAN) could improve diagnostic adherence.
- The no-biopsy pathway (NBP) offers potential benefits in resource-limited settings by reducing endoscopy needs.
Background:
Celiac disease (CD) is an immune-mediated systemic disorder elicited by the ingestion of gluten. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines published in 2012 suggested a no-biopsy pathway (NBP) for symptomatic children with IgA tissue transglutaminase (TGA-IgA) ≥10x upper limit of normal (ULN). Biopsy confirmation remained mandatory for other cases.
Objective:
This retrospective case note study was aimed at evaluating the adherence to the ESPGHAN 2012 guidelines for diagnosing CD in our unit.
Methods:
Forty-three cases with positive TGA-IgA were identified by a laboratory database search from January 2013 to December 2019. 6 of 43 patients were not referred for a confirmation of CD diagnosis. Data was collected on the diagnostic pathways followed, and appropriateness of adherence was compared with the existing ESPGHAN guidelines.
Results:
A total of 37 cases were included with 35 children diagnosed with CD. 29/35 (83%) were diagnosed via the NBP;15/29 (52%) children did not meet all the criteria required for NBP, but were diagnosed and managed as having CD. 20/35 (57%) children were diagnosed with CD in adherence to the 2012 guidelines.
Conclusion:
The recommended diagnostic guidelines were frequently not implemented; adherence to the guidelines may improve following regular educational sessions. The revised 2020 ESPGHAN guidelines which exclude HLA-DQ2/DQ8 testing would address the issue of diagnosis for the 10/15 NBP cases (with TGA-IgA >10xULN) in our study who did not have HLA testing and were therefore non-adherent to the 2012 diagnostic guidelines. NBP, with the reduced need for endoscopy may be beneficial in resource limited settings.
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