European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020

Steffen Husby, Sibylle Koletzko, Ilma Korponay-Szabó, Kalle Kurppa, M Luisa Mearin, Carmen Ribes-Koninckx, Raanan Shamir, Riccardo Troncone, Renata Auricchio, Gemma Castillejo, Robin Christensen, Jernej Dolinsek, Peter Gillett, Asbjørn Hróbjartsson, Tunde Koltai, Markku Maki, Sabrina Mai Nielsen, Alina Popp, Bucharest, Ketil Størdal & 2 andre Katharina Werkstetter, Margreet Wessels

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

OBJECTIVES: The ESPGHAN 2012 coeliac disease (CD) diagnostic guidelines aimed to guide physicians in accurately diagnosing CD and permit omission of duodenal biopsies in selected cases. Here, an updated and expanded evidence-based guideline is presented.

METHODS: Literature databases and other sources of information were searched for studies that could inform on ten formulated questions on symptoms, serology, HLA genetics, and histopathology. Eligible articles were assessed using QUADAS2. GRADE provided a basis for statements and recommendations.

RESULTS: Various symptoms are suggested for case finding, with limited contribution to diagnostic accuracy. If CD is suspected, measurement of total serum IgA and IgA-antibodies against transglutaminase 2 (TGA-IgA) is superior to other combinations. We recommend against deamidated gliadin peptide antibodies (DGP-IgG/IgA) for initial testing. Only if total IgA is low/undetectable an IgG based test is indicated. Patients with positive results should be referred to a paediatric gastroenterologist/specialist. If TGA-IgA is ≥10 times the upper limit of normal (10xULN) and the family agrees, the no-biopsy diagnosis may be applied, provided endomysial antibodies (EMA-IgA) will test positive in a second blood sample. HLA DQ2-/DQ8 determination and symptoms are not obligatory criteria. In children with positive TGA-IgA <10xULN at least 4 biopsies from the distal duodenum and at least one from the bulb should be taken. Discordant results between TGA-IgA and histopathology may require re-evaluation of biopsies. Patients with no/mild histological changes (Marsh 0/I) but confirmed autoimmunity (TGA-IgA/EMA-IgA+) should be followed closely.

CONCLUSIONS: CD diagnosis can be accurately established with or without duodenal biopsies if given recommendations are followed.

OriginalsprogEngelsk
TidsskriftJournal of Pediatric Gastroenterology and Nutrition
ISSN0277-2116
DOI
StatusE-pub ahead of print - 17. sep. 2019

Fingeraftryk

Nutrition Policy
Celiac Disease
Gastroenterology
Pediatrics
Guidelines
Gliadin
Wetlands
Serology
Autoimmunity
Duodenum
Databases

Citer dette

Husby, Steffen ; Koletzko, Sibylle ; Korponay-Szabó, Ilma ; Kurppa, Kalle ; Mearin, M Luisa ; Ribes-Koninckx, Carmen ; Shamir, Raanan ; Troncone, Riccardo ; Auricchio, Renata ; Castillejo, Gemma ; Christensen, Robin ; Dolinsek, Jernej ; Gillett, Peter ; Hróbjartsson, Asbjørn ; Koltai, Tunde ; Maki, Markku ; Nielsen, Sabrina Mai ; Popp, Alina ; Bucharest ; Størdal, Ketil ; Werkstetter, Katharina ; Wessels, Margreet. / European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. I: Journal of Pediatric Gastroenterology and Nutrition. 2019.
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title = "European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020",
abstract = "OBJECTIVES: The ESPGHAN 2012 coeliac disease (CD) diagnostic guidelines aimed to guide physicians in accurately diagnosing CD and permit omission of duodenal biopsies in selected cases. Here, an updated and expanded evidence-based guideline is presented.METHODS: Literature databases and other sources of information were searched for studies that could inform on ten formulated questions on symptoms, serology, HLA genetics, and histopathology. Eligible articles were assessed using QUADAS2. GRADE provided a basis for statements and recommendations.RESULTS: Various symptoms are suggested for case finding, with limited contribution to diagnostic accuracy. If CD is suspected, measurement of total serum IgA and IgA-antibodies against transglutaminase 2 (TGA-IgA) is superior to other combinations. We recommend against deamidated gliadin peptide antibodies (DGP-IgG/IgA) for initial testing. Only if total IgA is low/undetectable an IgG based test is indicated. Patients with positive results should be referred to a paediatric gastroenterologist/specialist. If TGA-IgA is ≥10 times the upper limit of normal (10xULN) and the family agrees, the no-biopsy diagnosis may be applied, provided endomysial antibodies (EMA-IgA) will test positive in a second blood sample. HLA DQ2-/DQ8 determination and symptoms are not obligatory criteria. In children with positive TGA-IgA <10xULN at least 4 biopsies from the distal duodenum and at least one from the bulb should be taken. Discordant results between TGA-IgA and histopathology may require re-evaluation of biopsies. Patients with no/mild histological changes (Marsh 0/I) but confirmed autoimmunity (TGA-IgA/EMA-IgA+) should be followed closely.CONCLUSIONS: CD diagnosis can be accurately established with or without duodenal biopsies if given recommendations are followed.",
author = "Steffen Husby and Sibylle Koletzko and Ilma Korponay-Szab{\'o} and Kalle Kurppa and Mearin, {M Luisa} and Carmen Ribes-Koninckx and Raanan Shamir and Riccardo Troncone and Renata Auricchio and Gemma Castillejo and Robin Christensen and Jernej Dolinsek and Peter Gillett and Asbj{\o}rn Hr{\'o}bjartsson and Tunde Koltai and Markku Maki and Nielsen, {Sabrina Mai} and Alina Popp and Bucharest and Ketil St{\o}rdal and Katharina Werkstetter and Margreet Wessels",
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Husby, S, Koletzko, S, Korponay-Szabó, I, Kurppa, K, Mearin, ML, Ribes-Koninckx, C, Shamir, R, Troncone, R, Auricchio, R, Castillejo, G, Christensen, R, Dolinsek, J, Gillett, P, Hróbjartsson, A, Koltai, T, Maki, M, Nielsen, SM, Popp, A, Bucharest, Størdal, K, Werkstetter, K & Wessels, M 2019, 'European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020', Journal of Pediatric Gastroenterology and Nutrition. https://doi.org/10.1097/MPG.0000000000002497

European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. / Husby, Steffen; Koletzko, Sibylle; Korponay-Szabó, Ilma; Kurppa, Kalle; Mearin, M Luisa; Ribes-Koninckx, Carmen; Shamir, Raanan; Troncone, Riccardo; Auricchio, Renata; Castillejo, Gemma; Christensen, Robin; Dolinsek, Jernej; Gillett, Peter; Hróbjartsson, Asbjørn; Koltai, Tunde; Maki, Markku; Nielsen, Sabrina Mai; Popp, Alina; Bucharest; Størdal, Ketil; Werkstetter, Katharina; Wessels, Margreet.

I: Journal of Pediatric Gastroenterology and Nutrition, 17.09.2019.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020

AU - Husby, Steffen

AU - Koletzko, Sibylle

AU - Korponay-Szabó, Ilma

AU - Kurppa, Kalle

AU - Mearin, M Luisa

AU - Ribes-Koninckx, Carmen

AU - Shamir, Raanan

AU - Troncone, Riccardo

AU - Auricchio, Renata

AU - Castillejo, Gemma

AU - Christensen, Robin

AU - Dolinsek, Jernej

AU - Gillett, Peter

AU - Hróbjartsson, Asbjørn

AU - Koltai, Tunde

AU - Maki, Markku

AU - Nielsen, Sabrina Mai

AU - Popp, Alina

AU - Bucharest, null

AU - Størdal, Ketil

AU - Werkstetter, Katharina

AU - Wessels, Margreet

PY - 2019/9/17

Y1 - 2019/9/17

N2 - OBJECTIVES: The ESPGHAN 2012 coeliac disease (CD) diagnostic guidelines aimed to guide physicians in accurately diagnosing CD and permit omission of duodenal biopsies in selected cases. Here, an updated and expanded evidence-based guideline is presented.METHODS: Literature databases and other sources of information were searched for studies that could inform on ten formulated questions on symptoms, serology, HLA genetics, and histopathology. Eligible articles were assessed using QUADAS2. GRADE provided a basis for statements and recommendations.RESULTS: Various symptoms are suggested for case finding, with limited contribution to diagnostic accuracy. If CD is suspected, measurement of total serum IgA and IgA-antibodies against transglutaminase 2 (TGA-IgA) is superior to other combinations. We recommend against deamidated gliadin peptide antibodies (DGP-IgG/IgA) for initial testing. Only if total IgA is low/undetectable an IgG based test is indicated. Patients with positive results should be referred to a paediatric gastroenterologist/specialist. If TGA-IgA is ≥10 times the upper limit of normal (10xULN) and the family agrees, the no-biopsy diagnosis may be applied, provided endomysial antibodies (EMA-IgA) will test positive in a second blood sample. HLA DQ2-/DQ8 determination and symptoms are not obligatory criteria. In children with positive TGA-IgA <10xULN at least 4 biopsies from the distal duodenum and at least one from the bulb should be taken. Discordant results between TGA-IgA and histopathology may require re-evaluation of biopsies. Patients with no/mild histological changes (Marsh 0/I) but confirmed autoimmunity (TGA-IgA/EMA-IgA+) should be followed closely.CONCLUSIONS: CD diagnosis can be accurately established with or without duodenal biopsies if given recommendations are followed.

AB - OBJECTIVES: The ESPGHAN 2012 coeliac disease (CD) diagnostic guidelines aimed to guide physicians in accurately diagnosing CD and permit omission of duodenal biopsies in selected cases. Here, an updated and expanded evidence-based guideline is presented.METHODS: Literature databases and other sources of information were searched for studies that could inform on ten formulated questions on symptoms, serology, HLA genetics, and histopathology. Eligible articles were assessed using QUADAS2. GRADE provided a basis for statements and recommendations.RESULTS: Various symptoms are suggested for case finding, with limited contribution to diagnostic accuracy. If CD is suspected, measurement of total serum IgA and IgA-antibodies against transglutaminase 2 (TGA-IgA) is superior to other combinations. We recommend against deamidated gliadin peptide antibodies (DGP-IgG/IgA) for initial testing. Only if total IgA is low/undetectable an IgG based test is indicated. Patients with positive results should be referred to a paediatric gastroenterologist/specialist. If TGA-IgA is ≥10 times the upper limit of normal (10xULN) and the family agrees, the no-biopsy diagnosis may be applied, provided endomysial antibodies (EMA-IgA) will test positive in a second blood sample. HLA DQ2-/DQ8 determination and symptoms are not obligatory criteria. In children with positive TGA-IgA <10xULN at least 4 biopsies from the distal duodenum and at least one from the bulb should be taken. Discordant results between TGA-IgA and histopathology may require re-evaluation of biopsies. Patients with no/mild histological changes (Marsh 0/I) but confirmed autoimmunity (TGA-IgA/EMA-IgA+) should be followed closely.CONCLUSIONS: CD diagnosis can be accurately established with or without duodenal biopsies if given recommendations are followed.

U2 - 10.1097/MPG.0000000000002497

DO - 10.1097/MPG.0000000000002497

M3 - Journal article

JO - Journal of Pediatric Gastroenterology and Nutrition

JF - Journal of Pediatric Gastroenterology and Nutrition

SN - 0277-2116

ER -