Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Nov 15:2019:9370397.
doi: 10.1155/2019/9370397. eCollection 2019.

The Use of Biopsy and "No-Biopsy" Approach for Diagnosing Paediatric Coeliac Disease in the Central European Region

Petra Riznik  1 , Márta Balogh  2 , Piroska Bódi  3 , Luigina De Leo  4 , Jasmina Dolinsek  5 , Ildikó Guthy  6 , Judit Gyimesi  7 , Ágnes Horváth  8 , Ildikó Kis  9 , Martina Klemenak  1 , Berthold Koletzko  10   11 , Sibylle Koletzko  11   12 , Ilma Rita Korponay-Szabó  7   13 , Tomaz Krencnik  1 , Tarcisio Not  4 , Goran Palcevski  14 , Éva Pollák  15 , Daniele Sblattero  16 , István Tokodi  17 , Matej Vogrincic  18 , Katharina Julia Werkstetter  11 , Jernej Dolinsek  1   19
Affiliations

The Use of Biopsy and "No-Biopsy" Approach for Diagnosing Paediatric Coeliac Disease in the Central European Region

Petra Riznik et al. Gastroenterol Res Pract. .

Abstract

Objectives: The current European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines introduced the option to diagnose coeliac disease (CD) in children and adolescents without upper endoscopy if the defined criteria are met. The aim of our study was to evaluate how frequently paediatric gastroenterologists in Central Europe used the "no-biopsy" approach and how often the duodenal biopsy could have been omitted.

Methods: Medical records of patients aged < 19 years diagnosed with CD in 2016 from five European countries were analysed, focusing on levels of transglutaminase antibodies (TGA) at the time of diagnosis and on whether the diagnosis was confirmed using duodenal biopsy or "no-biopsy" approach. Clinical presentation and delays until final diagnosis were analysed according to diagnostic approach.

Results: Data from 653 children (63.9% female, median age: 7 years, range: 7 months-18.5 years) from Croatia, Hungary, Germany, Italy, and Slovenia were analysed. One fifth (n = 134) of included children were asymptomatic at diagnosis. Of 519 symptomatic children, 107 (20.6%) were diagnosed by the "no-biopsy" approach. Out of the remaining 412 children who underwent duodenal biopsies, 214 (51.9%) had TGA ≥ 10 times upper level of normal (ULN) and would have been eligible for the "no-biopsy" approach. Signs and symptoms of malabsorption were more frequent in children diagnosed without duodenal biopsies. There were no differences in diagnostic delays with respect to the diagnostic approach.

Conclusion: In this cohort, about 60% of symptomatic CD patients could have been diagnosed without duodenal biopsies. The aim of the "no-biopsy" approach was to make the diagnostic procedure less challenging without compromising its reliability. However, this option was applied only in 20%, in spite of fewer burdens to the family and reduced costs. The reasons for this discrepancy are unknown. Physicians should be made more aware about the reliability of CD diagnosis without biopsies when the ESPGHAN guidelines for CD diagnosis are followed.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Diagnostic approach in children with CD in CE. ∗15 patients had IgA deficiency.
See this image and copyright information in PMC

References

    1. Husby S., Koletzko S., Korponay-Szabó I. R., et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the diagnosis of coeliac disease. Journal of Pediatric Gastroenterology and Nutrition. 2012;54(1):136–160. doi: 10.1097/mpg.0b013e31821a23d0. - DOI - PubMed
    1. Dickson B. C., Streutker C. J., Chetty R. Coeliac disease: an update for pathologists. Journal of Clinical Pathology. 2006;59:1008–1016. doi: 10.1136/jcp.2005.035345. - DOI - PMC - PubMed
    1. Marsh N. M., Johnson W. M., Rostami K. Mucosal histopathology in celiac disease: a rebuttal of Oberhuber’s sub-division of Marsh III. Gastroenterology and Hepatology from Bed to Bench. 2015;8(2):99–109. - PMC - PubMed
    1. Husby S., Murray J. Diagnosing coeliac disease and the potential for serological markers. Nature Reviews Gastroenterology & Hepatology. 2014;11(11):655–663. doi: 10.1038/nrgastro.2014.162. - DOI - PubMed
    1. McNeish A., Harms H., Rey J., Shmerling D., Visakorpi J., Walker-Smith J. The diagnosis of coeliac disease. A commentary on the current practices of members of the European Society for Paediatric Gastroenterology and Nutrition (ESPGAN) Archives of Disease in Childhood. 1979;54(10):783–786. doi: 10.1136/adc.54.10.783. - DOI - PMC - PubMed

LinkOut - more resources