Pediatric gastroenterologists practice styles and adherence to international guidelines for pediatric celiac disease

To evaluate adherence to established European and North American guidelines among pediatric gastroenterologists in the diagnosis of celiac disease, and to characterize contemporary clinical practice patterns.

A 26-item anonymous survey assessing diagnostic strategies, endoscopic practices, follow-up care, and dietary management was developed. The survey was distributed via an international pediatric gastroenterology listserv between January and February 2025. Only fully completed responses were analyzed. Descriptive statistics were used to summarize responses, and subgroup analyses were performed by geographic region.

A total of 203 respondents from 27 countries completed the survey, with most practicing in the United States (72.9%) and in tertiary or quaternary care centers (81.8%). Tissue transglutaminase immunoglobulin A (IgA) was nearly universally used for screening; however, variability existed in the use of total IgA and definitions of IgA deficiency. Endoscopic practices diverged, particularly at high serologic thresholds, with non-USA providers more likely to adopt non-biopsy diagnostic approaches (p < 0.001). Follow-up intervals were largely guideline-concordant, and laboratory monitoring and micronutrient assessment varied. Dietitian involvement and use of validated adherence tools were limited. Gluten challenge practices demonstrated substantial heterogeneity. Guideline utilization differed by region, with U.S. providers favoring North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and international providers favoring European Society for Paediatric Gastroenterology, Hepatology and Nutrition recommendations.

While overall adherence to celiac disease guidelines among pediatric gastroenterologists is high, meaningful variability persists in diagnostic thresholds, biopsy practices, follow-up care, and dietary assessment. These findings highlight ongoing differences in international practice and underscore the need for harmonized, updated guidelines to support standardized care.