Diagnosing coeliac disease

• Published in: Archives of Disease in Childhood Vol. 97; no. 5; pp. 393 - 394
• Main Authors: Jenkins, H R, Murch, S H, Beattie, R M
• Format: Journal Article Book Review
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.05.2012; BMJ Publishing Group; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: Age; Biological and medical sciences; Celiac disease; Celiac Disease - diagnosis; Child; Child, Preschool; Diabetes; Diagnosis; Diagnostic Tests; Diet; Down Syndrome; Evidence; Evidence-Based Medicine - methods; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Gluten; Guidelines; Hepatology; Histocompatibility Testing - methods; Histology; Humans; Immunoglobulins; Infant; Laboratories; Medical case management; Medical sciences; Methods; Miscellaneous; Nutrition; Other diseases. Semiology; Patients; Practice guidelines (Medicine); Practice Guidelines as Topic; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Serodiagnosis; Serologic tests; Serologic Tests - methods; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Test Results; Working groups; Young Adults; United Kingdom; Human; Immunopathology; Pediatrics; Intestinal malabsorption; Digestive diseases; Intestinal disease; Diagnosis; Coeliac disease; Child; Public health
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2011-301198

Diagnosis can be made at any age but it is clear that it is important to diagnose CD in children with obvious gastrointestinal symptoms and in children with a less clear clinical picture, as the disease may have negative health consequences in the longer term. Since the previous ESPGHAN criteria, serological tests with high accuracy have become available, as well as other diagnostic tests that, in conjunction with biopsy and response to gluten exclusion, allow a firm diagnosis to be made in the majority of patients. The clinical relevance of positive antibodies should be confirmed by histology unless certain conditions are fulfilled which allow the option to omit confirmatory biopsies. [...]the recommendation is that in children and young people with signs of symptoms suggestive of CD and very high anti- TTG2 levels exceeding 10 times the upper limit of normal, the likelihood of villous atrophy on a small intestinal biopsy is very high.\n We now know that patients with an increased genetic risk for CD may have fluctuating levels of CD specific antibodies and thus, in this group of individuals without classical clinical signs and symptoms, the duodenal biopsy with the demonstration of enteropathy should always be part of the diagnosis of CD.