Celiac.com 04/13/2020 - Current guidelines set by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN), permit doctors to diagnose celiac disease without upper endoscopy in children and adolescents who meet specific criteria.
A team of researchers recently set out to to assess exactly how many pediatric gastroenterologists in Central Europe used the “no-biopsy” approach to make a celiac diagnosis, and how many biopsies could have been avoided.
The team analyzed 2016 medical records for celiac patients under 19 years old, who were diagnosed in five European countries. They concentrated on transglutaminase antibody (TGA) levels at diagnosis, and on whether celiac diagnosis was confirmed with or without duodenal biopsy. Using diagnostic guidelines, they also noted clinical presentation and any delays in the final diagnosis.
The gathered data from 653 children from Croatia, Hungary, Germany, Italy, and Slovenia. Subjects ranged in age from 7 months-18.5 years, with an average patient age of 7 years. Just under 64% were female,
A total of 134 children were asymptomatic at diagnosis. Of 519 children who did show symptoms, 107, nearly 21%, were diagnosed without biopsy. Out of 412 children diagnosed via biopsy, 214, or nearly 52% had TGA at or above 10 times upper level of normal (ULN) and thus could have been diagnosed without biopsy. Signs and symptoms of malabsorption were more frequent in children diagnosed without duodenal biopsies.
The data showed no differences in diagnostic times with the no-biopsy approach. In this study, about 60% of celiac patients who show symptoms could have been diagnosed without duodenal biopsies. However, only 20% of eligible patients are getting a biopsy-free celiac diagnosis.
The research team recommends educating doctors about the ease and reliability of biopsy-free celiac diagnosis as part of the ESPGHAN guidelines.
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The researchers are variously affiliated with the University Medical Centre Maribor, Department of Paediatrics, Gastroenterology, Hepatology and Nutrition Unit, Maribor, Slovenia; Markusovszky Teaching Hospital, Szombathely, Hungary, Pándy Kálmán Hospital, Gyula, Hungary; IRCCS Burlo Garofolo Trieste, Institute for Maternal and Child Health, Trieste, Italy; Municipality of Maribor, Project Office, Maribor, Slovenia; Jósa András County Hospital, Nyíregyháza, Hungary; Heim Pál National Paediatric Institute, Coeliac Disease Centre, Budapest, Hungary; Csolnoky Ferenc County Hospital, Veszprém, Hungary; St. Barbara County Hospital, Tatabánya, Hungary; Stiftung Kindergesundheit (Child Health Foundation) at Dr. von Hauner Children’s Hospital, LMU Munich, Munich, Germany; Dr. von Hauner Children’s Hospital, Clinical Medical Centre, LMU Munich, Munich, Germany; Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland; University of Debrecen, Faculty of Medicine, Department of Paediatrics, Debrecen, Hungary; University Hospital Rijeka, Department for Gastroenterology, Paediatric Clinic, Rijeka, Croatia; Ajka County Hospital, Ajka, Hungary; University of Trieste, Trieste, Italy; St. George Fejér County University Teaching Hospital, Székesfehérvár, Hungary; University Medical Centre Maribor, Department of Informatics, Maribor, Slovenia; and the Medical Faculty, Department of Paediatrics, University of Maribor, Maribor, Slovenia.