Author, as appears in the article.: Husby S; Koletzko S; Korponay-Szabó I; Kurppa K; Mearin ML; Ribes-Koninckx C; Shamir R; Troncone R; Auricchio R; Castillejo G; Christensen R; Dolinsek J; Gillett P; Hróbjartsson A; Koltai T; Maki M; Nielsen SM; Popp A; Størdal K; Werkstetter K; Wessels M
Department: Medicina i Cirurgia
URV's Author/s: Castillejo De Villasante, Gemma
Keywords: Meta-analysis Diagnostic tests Coeliac disease Children and adolescents
Abstract: © ESPGHAN and NASPGHAN. All rights reserved. Objectives:The ESPGHAN 2012 coeliac disease (CD) diagnostic guidelines aimed to guide physicians in accurately diagnosing CD and permit omission of duodenal biopsies in selected cases. Here, an updated and expanded evidence-based guideline is presented.Methods:Literature databases and other sources of information were searched for studies that could inform on 10 formulated questions on symptoms, serology, HLA genetics, and histopathology. Eligible articles were assessed using QUADAS2. GRADE provided a basis for statements and recommendations.Results:Various symptoms are suggested for case finding, with limited contribution to diagnostic accuracy. If CD is suspected, measurement of total serum IgA and IgA-antibodies against transglutaminase 2 (TGA-IgA) is superior to other combinations. We recommend against deamidated gliadin peptide antibodies (DGP-IgG/IgA) for initial testing. Only if total IgA is low/undetectable, an IgG-based test is indicated. Patients with positive results should be referred to a paediatric gastroenterologist/specialist. If TGA-IgA is ≥10 times the upper limit of normal (10× ULN) and the family agrees, the no-biopsy diagnosis may be applied, provided endomysial antibodies (EMA-IgA) will test positive in a second blood sample. HLA DQ2-/DQ8 determination and symptoms are not obligatory criteria. In children with positive TGA-IgA <10× ULN at least 4 biopsies from the distal duodenum and at least 1 from the bulb should be taken. Discordant results between TGA-IgA and histopathology may require re-evaluation of biopsies. Patients with no/mild histological changes (Marsh 0/I) but confirmed autoimmunity (TGA-IgA/EMA-IgA+) should be followed closely.Conclusions:CD diagnosis can be accurately established with or without duodenal biopsies if given recommendations are followed.
Thematic Areas: Saúde coletiva Química Pediatrics, perinatology and child health Pediatrics Odontología Nutrition & dietetics Nutrição Medicine (all) Medicina veterinaria Medicina iii Medicina ii Medicina i Interdisciplinar General medicine Gastroenterology & hepatology Gastroenterology Farmacia Ensino Engenharias iv Educação física Ciências biológicas iii Ciências biológicas ii Ciências biológicas i Ciência de alimentos Biotecnología
licence for use: https://creativecommons.org/licenses/by/3.0/es/
ISSN: 15364801
Author's mail: gemma.castillejo@urv.cat
Record's date: 2023-02-26
Papper version: info:eu-repo/semantics/acceptedVersion
Papper original source: Journal Of Pediatric Gastroenterology And Nutrition. 70 (1): 141-156
APA: Husby S; Koletzko S; Korponay-Szabó I; Kurppa K; Mearin ML; Ribes-Koninckx C; Shamir R; Troncone R; Auricchio R; Castillejo G; Christensen R; Dolinsek (2020). European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. Journal Of Pediatric Gastroenterology And Nutrition, 70(1), 141-156. DOI: 10.1097/MPG.0000000000002497
Licence document URL: https://repositori.urv.cat/ca/proteccio-de-dades/
Entity: Universitat Rovira i Virgili
Journal publication year: 2020
Publication Type: Journal Publications
Repositori URV