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Coeliac disease in the ERA of the new ESPGHAN and BSPGHAN guidelines: a prospective cohort study
Open accessAbstract
Objective: To evaluate the consequences of the last European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) guidelines for the diagnosis of coeliac disease (CD) by means of a prospective study. Design: Prospective cohort study. Setting: Institute for Maternal and Child Health IRCCS Burlo Garofolo (Trieste, Italy). Patients: Children diagnosed with CD without a duodenal biopsy (group 1), following the last ESPGHAN and BSPGHAN guidelines, and children diagnosed with a duodenal biopsy, matched for sex, age and year of diagnosis (group 2), were prospectively enrolled over a 3-year period. All patients were put on a gluten-free diet (GFD) and were followed up for clinical conditions and laboratory testing at 6 months every year since diagnosis (median follow up: 1.9 years). Outcome measures: Resolution of symptoms, body mass index, laboratory testing (haemoglobin, anti-transglutaminase IgA), adherence to a GFD, quality of life, and supplementary post-diagnosis medical consultations. Results: 51 out of 468 (11%) patients were diagnosed without a duodenal biopsy (group 1; median age 2.1 years) and matched to 92 patients diagnosed with a biopsy (group 2; median age 2.4 years). At the end of follow-up the two groups were statistically comparable in terms of clinical and nutritional status, anti-transglutaminase IgA antibody titres, quality of life, adherence to a GFD, and number of supplementary medical consultations. Conclusions: On the basis of this prospective study, diagnosis of CD can be reliably performed without a duodenal biopsy in approximately 11% of cases. At least during a medium-term follow-up, this approach has no negative consequences relating to clinical remission, adherence to diet, and quality of life of children with CD.
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Five of six studies using celiac disease-specific health-related quality of life questionnaires found that the health-related quality of life of children and adolescents with celiac disease was poor or neutral.
“However, five of the six studies using CD-specific HRQOL questionnaires (CDDUX, CDQL, CDQOL Scale-KINDL, CDPQOL) found that the HRQOL of children and adolescents with CD was poor or neutral (82, 96, 100, 105, 109).”
From ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease. (2022) · cites this paper as [82]
The Follow-up and diet section says the study used a simplified Kindl test to assess quality of life. Contrary to the outcome attributed to it, the Discussion reports that all patients felt “good or very good” at the last follow-up visit. The paper does not report a five-of-six-studies tally. (LLM, conf=0.88)
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Experimental — accuracy not yet measuredNine studies found similar health-related quality of life in children with celiac disease as in control children.
“Nine of these studies found similar HRQOL in children with CD as in control children (4, 82, 95, 96, 99, 100, 102, 103, 106).”
From ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease. (2022) · cites this paper as [82]
The Results (page unavailable) report similar quality-of-life scores in two groups of children with coeliac disease: those diagnosed with and without a biopsy. The paper does not compare children with coeliac disease against control children, so it does not support the stated comparator. (LLM, conf=0.88)
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- [No authors listed]. Revised criteria for diagnosis of coeliac disease. Report of Working Group of European Society of Paediatric Gastroenterology and Nutrition. Arch Dis Child 1990;65:909–11. · DOI
- Murch, 2013, Joint BSPGHAN and Coeliac UK guidelines for the diagnosis and management of coeliac disease in children, Arch Dis Child, 98, 806, 10.1136/archdischild-2013-303996 · DOI
- Nevoral, 2014, Symptom positivity is essential for omitting biopsy in children with suspected celiac disease according to the new ESPGHAN guidelines, Eur J Pediatr, 173, 497, 10.1007/s00431-013-2215-0 · DOI
- Klapp, 2013, Celiac disease: the new proposed ESPGHAN diagnostic criteria do work well in a selected population, J Pediatr Gastroenterol Nutr, 56, 251, 10.1097/MPG.0b013e318279887b · DOI
- Gidrewicz, 2015, Evaluation of the ESPGHAN Celiac Guidelines in a North American Pediatric Population, Am J Gastroenterol, 110, 760, 10.1038/ajg.2015.87 · DOI
- Oberhuber, 1999, The histopathology of coeliac disease: time for a standardized report scheme for pathologists, Eur J Gastroenterol Hepatol, 11, 1185, 10.1097/00042737-199910000-00019 · DOI
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Cited by
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ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease.
Mearin, M. L., Agardh, D., Antunes, H., Al‐toma, A., Auricchio, R., Castillejo, G., Catassi, C., Ciacci, C., Discepolo, V., Dolinsek, J., et al. (2022) · Journal of pediatric gastroenterology and nutrition · doi:10.1097/mpg.0000000000003540 · Cited by 186
Metadata
- Authors
- Benelli, E., Carrato, V., Martelossi, S., Ronfani, L., Not, T., & Ventura, A.
- Affiliations
- University of Trieste (IT)
- IRCCS Materno Infantile Burlo Garofolo (IT)
- Corresponding author
- Benelli, Elisa
- Venue
- Archives of Disease in Childhood
- Publisher
- BMJ
- Published
- 2015-11-17
- Volume
- 101
- Issue
- 2
- Pages
- 172-176
- ISSN
- 0003-9888 (ISSN-L)
- 1468-2044
- OpenAlex
- W2175881665
- Cited by
- 36
- References
- 0
- Citations by year
- 2026: 2 · 2024: 5 · 2022: 2 · 2021: 3 · 2020: 5 · 2019: 2 · 2018: 5 · 2017: 9 · 2016: 2
- FWCI
- 5.59
- Type
- journal article
- Language
- en
- Open access
- green
- adc.bmj.com
- Licence
- cc-by-nc
- Locations
- Archives of Disease in Childhood (publishedVersion)
- PubMed (publishedVersion)
- ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, cc-by-nc)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
- Health Sciences › Medicine › Gastroenterology › Eosinophilic Esophagitis
- Health Sciences › Medicine › Surgery › Gastrointestinal disorders and treatments
- Keywords
- celiac disease, non-biopsy diagnosis, duodenal biopsy, ESPGHAN guidelines, children, gluten-free diet adherence, quality of life, clinical remission, nutritional status
- MeSH terms
- Adolescent, Biopsy, Celiac Disease, Child, Child, Preschool, Duodenum, Female, Humans, Immunoglobulin A, Infant, Infant, Newborn, Italy, Male, Patient Compliance, Prospective Studies, Transglutaminases, Quality of Life, Cohort Studies, Practice Guidelines as Topic, Age Distribution, Unnecessary Procedures, Diet, Gluten-Free
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