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. 2019 Jan 12:20:13-18.
eCollection 2019 Jul-Dec.

Current Espghan Guidelines for Celiac Disease in Pediatric Age, Tertiary Care Center Experience: A Proposal for Further Simplification

M Malamisura  1 , R Colantuono  2 , V M Salvati  3 , R Croce  3 , G D'Adamo  3 , T Passaro  3 , E D'Angelo  3 , M Boffardi  3 , A Garzi  4 , B Malamisura  3
Affiliations

Current Espghan Guidelines for Celiac Disease in Pediatric Age, Tertiary Care Center Experience: A Proposal for Further Simplification

M Malamisura et al. Transl Med UniSa. .

Abstract

According to the 2012 ESPGHAN criteria for diagnosis of celiac disease (CD), duodenal biopsy (DB) can be avoided in children with a clear malabsorption syndrome, anti-tissue transglutaminase IgA (tTG2) ≥ 10x the cut-off, anti-endomysium IgA (EMA) and HLA DQ2/DQ8 genes. The aim of this study is to report our experience and evaluate the accuracy of the actual guidelines.

Patients and methods: This is a retrospective study conducted on all patients diagnosed CD from 2012 to 2018 in our Center. For all patients enrolled were analyzed: data of family history, symptoms, serology, genetics, Marsh grade and follow-up.

Results: A total of 481 children [mean age 6,4 yrs; F:M= 1.8:1] were included in the study. The mean age of patients who were not subject to DB was lower (4.51 yrs) comparing with patients that received DB (6.48 yrs). Out of the 256 patients with anti-tTG2 ≥ 10 fold, 121 underwent DB because of mild symptoms (84/121) or no symptoms (37/121). In all cases Marsh type 3 was found and HLA haplotypes was compatible with CD diagnosis.

Conclusions: Our study confirms that the serology has a primary importance to diagnose CD, regardless of the symptoms. These data suggest that biopsy and HLA haplotypes search, in presence of anti-tTG2 IgA ≥ 10x the cut-off, are wasteful and unhelpful for the patients.

Keywords: anti-tissue transglutaminase; celiac disease; duodenal biopsy; haplotypes.

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Figures

Fig. 1
Fig. 1
Prevalence of CD diagnosis biopsy sparing during 2012–2018 (data from 2012 regard presumptive number of patients who could had avoid DB if applied ESPGHAN’s criteria)
Fig. 2
Fig. 2
Flow chart of eligible, recruited, and excluded patients and CD diagnosis of final cohort, classified for Anti-tTG2 and biopsy
Fig. 3
Fig. 3
Correlation between age at diagnosis, Anti-tTG2 values, symptoms, gender and years of diagnosis with biopsy. Anti-tTgG2 and age at diagnosis were significantly correlated with biopsy
See this image and copyright information in PMC

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