How useful is celiac disease without biopsy? Photo: CC--Military Health

Celiac.com 05/19/2016 - Using a prospective cohort study, a team of researchers recently set out to assess the outcomes of the latest celiac diagnosis guidelines from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN).

The research team included Elisa Benelli, Valentina Carrato, Stefano Martelossi, Luca Ronfani, Tarcisio Not, and Alessandro Ventura. They are variously affiliated with the Department of Medical, Surgical and Health Sciences, University of Trieste in Trieste, Italy, and the Institute for Maternal and Child Health IRCCS 'Burlo Garofolo' in Trieste, Italy. The study was conducted at the Institute for Maternal and Child Health IRCCS Burlo Garofolo in Trieste, Italy.

For the study, the team prospectively enrolled children diagnosed with celiac disease without a duodenal biopsy (group 1), following the last ESPGHAN and BSPGHAN guidelines, and children diagnosed with a duodenal biopsy, matched for sex, age and year of diagnosis (group 2). All of this was done over a 3-year period. The team made sure all patients were on a gluten-free diet (gluten-free diet) and then followed them for clinical conditions and laboratory testing at 6 months every year since diagnosis. The average follow up period was just under two years.

Their analysis looked at resolution of symptoms, body mass index, levels of hemoglobin and anti-transglutaminase IgA, adherence to a gluten-free diet, quality of life, and supplementary post-diagnosis medical consultations. Out of 468 patients, the team found 51 patients (11%) who were diagnosed without a duodenal biopsy (group 1; median age 2.1 years), and matched those patients to 92 patients diagnosed with a biopsy (group 2; median age 2.4 years).

At the end of follow-up the two groups showed statistically comparable clinical and nutritional status, anti-transglutaminase IgA antibody levels, quality of life, adherence to a gluten-free diet, and number of supplementary medical consultations.

This study indicates that celiac disease can be reliably diagnosed without a duodenal biopsy in approximately 11% of cases.

At least during a medium-term follow-up, this approach has no negative consequences relating to clinical remission, adherence to diet, and quality of life of children with celiac disease.

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