Coeliac disease

to biopsy or not?

Norelle R Reilly, Steffen Husby, David S Sanders, Peter H R Green

Research output: Contribution to journalReviewResearchpeer-review

Abstract

Coeliac disease is increasingly recognized as a global problem in both children and adults. Traditionally, the findings of characteristic changes of villous atrophy and increased intraepithelial lymphocytosis identified in duodenal biopsy samples taken during upper gastrointestinal endoscopy have been required for diagnosis. Although biopsies remain advised as necessary for the diagnosis of coeliac disease in adults, European guidelines for children provide a biopsy-sparing diagnostic pathway. This approach has been enabled by the high specificity and sensitivity of serological testing. However, these guidelines are not universally accepted. In this Perspective, we discuss the pros and cons of a biopsy-avoiding pathway for the diagnosis of coeliac disease, especially in this current era of the call for more biopsies, even from the duodenal bulb, in the diagnosis of coeliac disease. In addition, a contrast between paediatric and adult guidelines is presented.

Original languageEnglish
JournalNature Reviews. Gastroenterology & Hepatology
Volume15
Issue number1
Pages (from-to)60–66
ISSN1759-5045
DOIs
Publication statusPublished - Jan 2018

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Celiac Disease
Guidelines
Lymphocytosis
Pediatrics

Keywords

  • Adult
  • Age Factors
  • Biopsy
  • Celiac Disease/diagnosis
  • Child
  • Humans
  • Patient Selection

Cite this

Reilly, Norelle R ; Husby, Steffen ; Sanders, David S ; Green, Peter H R. / Coeliac disease : to biopsy or not?. In: Nature Reviews. Gastroenterology & Hepatology. 2018 ; Vol. 15, No. 1. pp. 60–66.
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Coeliac disease : to biopsy or not? / Reilly, Norelle R; Husby, Steffen; Sanders, David S; Green, Peter H R.

In: Nature Reviews. Gastroenterology & Hepatology, Vol. 15, No. 1, 01.2018, p. 60–66.

Research output: Contribution to journalReviewResearchpeer-review

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AU - Husby, Steffen

AU - Sanders, David S

AU - Green, Peter H R

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AB - Coeliac disease is increasingly recognized as a global problem in both children and adults. Traditionally, the findings of characteristic changes of villous atrophy and increased intraepithelial lymphocytosis identified in duodenal biopsy samples taken during upper gastrointestinal endoscopy have been required for diagnosis. Although biopsies remain advised as necessary for the diagnosis of coeliac disease in adults, European guidelines for children provide a biopsy-sparing diagnostic pathway. This approach has been enabled by the high specificity and sensitivity of serological testing. However, these guidelines are not universally accepted. In this Perspective, we discuss the pros and cons of a biopsy-avoiding pathway for the diagnosis of coeliac disease, especially in this current era of the call for more biopsies, even from the duodenal bulb, in the diagnosis of coeliac disease. In addition, a contrast between paediatric and adult guidelines is presented.

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