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Coeliac Disease Diagnosis: ESPGHAN 1990 Criteria or Need For a Change? Results of a Questionnaire

Ribes-Koninckx, C.*; Mearin, ML.; Korponay-Szabó, IR.; Shamir, R.§; Husby, S.||; Ventura, A.; Branski, D.#; Catassi, C.**; Koletzko, S.††; Mäki, M.‡‡; Troncone, R.§§; Zimmer, KP.||||; on Behalf of the ESPGHAN Working Group on Coeliac Disease Diagnosis

Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e31822a00bb
Original Articles: Gastroenterology

Background and Objectives: A revision of criteria for diagnosing coeliac disease (CD) is being conducted by The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). In parallel, we have performed a survey aimed to evaluate present practices for CD among paediatric gastroenterologists and to learn their views on the need for modification of present criteria for CD diagnosis.

Patients and Methods: Questionnaires were distributed to experienced paediatric gastroenterologists (ESPGHAN members) via the Internet.

Results: Overall, 95 valid questionnaires were available for analysis, pertaining to 28 different countries, with the majority of responders treating patients with CD for >15 years. Only about 12% of the responders comply with present criteria, noncompliance being related mainly to the challenge policy. Approximately 90% request a revision and modification of the present criteria. Forty-four percent want to omit the small bowel biopsy in symptomatic children with positive anti-tissue transglutaminase immunoglobulin (Ig) A or endomysial IgA antibodies, especially if they are DQ2/DQ8 positive. For silent cases detected by screening with convincingly positive anti-tissue transglutaminase IgA or EMA IgA, about 30% consider that no small bowel biopsy should be required in selected cases. Adding human leukocyte antigen typing in the diagnostic workup was asked for by 42% of the responders. As for gluten challenge, a new policy is advocated restricting its obligation to cases whenever the diagnosis is doubtful or unclear.

Conclusions: Based on these opinions, revision of the ESPGHAN criteria for diagnosing CD is urgently needed.

Author Information

*Pediatric Gastroenterology Unit, La Fe University Hospital, Valencia, Spain

Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands

Department of Paediatrics, Medical and Health Science Centre, University of Debrecen, Nagyerdei, Debrecen, and Heim Pal Children's Hospital, Budapest, Hungary

§Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center of Israel, Tel-Aviv University, Tel-Aviv, Israel

||Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark

Department of Paediatrics, Institute for Child Health IRCCS Burlo Garofolo, University of Trieste, Trieste, Italy

#Department of Paediatrics, Hadassah University Hospitals, Jerusalem, Israel

**Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy

††Dr von Haunersches Kinderspital, Ludwig Maximilians Universität München Lindwurmstr, München, Germany

‡‡Pediatric Research Center, University of Tampere and Tampere University Hospital, Tampere, Finland

§§Department of Pediatrics and European Laboratory for the Investigation of Food Induced Diseases, University Federico II, Naples, Italy

||||Zentrum für Kinderheilkunde und Jugendmedizin, Allgemeine Pädiatrie und Neonatologie, Justus-Liebig-Universität, Feulgenstr, Gießen, Germany.

Address correspondence and reprint requests to C. Ribes Koninckx, Pediatric Gastroenterology, La Fe University Hospital, Valencia, Spain (e-mail:

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Received 4 May, 2011

Accepted 17 June, 2011

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN