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J Pediatr Gastroenterol Nutr. 2016 Feb;62(2):284-91. doi: 10.1097/MPG.0000000000000870.

ESPGHAN 2012 Guidelines for Coeliac Disease Diagnosis: Validation Through a Retrospective Spanish Multicentric Study.

Author information

1
*Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Universitari i Politècnic La Fe, Valencia †Pediatric Gastroenterology, Complejo Hospitalario Universitario de Vigo, Vigo ‡Pediatric Gastroenterology, Hospital Virgen del Camino, Pamplona §Pediatric Gastroenterology and Nutrtion, Hospital Teresa Herrrera, A Coruña ||Pediatric Gastroenterology, Hospital Universitario Niño Jesus, Madrid ¶Pediatric Gastroenterology, Hepatology and Nutrition Unit, Pediatrics Department, Hospital Clínico Universitario de Santiago, Pediatrics Nutrition Research Group-IDIS, Universidad de Santiago de Compostela, Santiago de Compostela #Pediatric Gastroenterology and Nutrition Unit, Hospital Materno-Infantil, Universidad de Las Palmas de Gran Canaria, Las Palmas and CIBER OBN ††Pediatric Gastroenterology, Hospital Universitari de Sant Joan de Reus, Reus ‡‡Pediatric Gastroenterology, Hospital Severo Ochoa, Madrid §§Pediatric Gastroenterology, Hospital de Txagorritxu, Vitoria ||||Pediatric Gastroenterology, Hospital Universitario Ntra Sra de Candelaria, Tenerife ¶¶Pediatric Gastroenterology, Hospital General de Albacete, Albacete ##Pediatric Gastroenterology, Hospital Clínico Universitario de Valladolid, Valladolid ***Pediatric Gastroenterology Unit, Hospital Donostia, San Sebastian †††Pediatric Gastroenterology, Hospital Universitario de Basurto, Bilbao ‡‡‡Pediatric Gastroenterology, Hospital Universitario de Fuenlabrada, Madrid §§§Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Universitari i Politècnic La Fe, Valencia, Spain.

Abstract

OBJECTIVES:

A large retrospective multicentre study was conducted in Spain to evaluate the efficiency of the new European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) criteria for the diagnosis of coeliac disease (CD).

METHODS:

The study protocol was approved by the ethics committee of Hospital Universitari i Politècnic La Fe (Valencia, Spain). The present study included 2177 children (ages 0.6-15.9 years) with small bowel biopsy (SBB) performed for diagnostic purposes (from 2000 to 2009) and with a minimum 2-year follow-up after biopsy.

RESULTS:

CD was diagnosed in 2126 patients (97.5%) and excluded in 51 (2.5%). Tissue transglutaminase antibodies (TG2A), anti-endomysial antibodies (EMA), and human leukocyte antigen (HLA) were reported in 751 patients, 640 symptomatic and 111 asymptomatic. TG2A levels >10 times the upper limit of normal, plus positive EMA and HLA DQ2 and/or DQ8 haplotypes, were found in 336 symptomatic patients, all of them with final diagnosis of CD. In 65 of 69 asymptomatic patients, 65 had confirmed CD and 4 did not have CD. According to the 2012 ESPGHAN guidelines, SBB may have been omitted in 52% of the symptomatic patients with CD with serologic and HLA available data. Gluten challenge was performed in 158 children, 75 of them <2 years at first biopsy. Only 1 patient in whom according to the new proposed diagnostic criteria gluten challenge would not have been mandatory did not relapse.

CONCLUSIONS:

Our results support the new ESPGHAN 2012 guidelines for diagnosis of CD can be safely used without the risk of overdiagnosis. A prospective multicentre study is needed to confirm our results.

PMID:
26020370
DOI:
10.1097/MPG.0000000000000870
[Indexed for MEDLINE]

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