Diagnosis of Coeliac Disease in Children Younger Than 2 Years

Mišak, Zrinjka; Hojsak, Iva; Jadrešin, Oleg; Kekez, Alemka Jaklin; Abdović, Slaven; Kolaček, Sanja

Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e3182716861
Original Articles: Gastroenterology
Abstract

Background and Aim: To diagnose coeliac disease (CD) in children younger than 2 years, the old ESPGHAN criteria based on 3 small bowel biopsies were recommended until recently. The aim of the present study was to investigate the applicability of only 1 small intestinal biopsy plus positive serology for the diagnosis of CD in children younger than 2 years.

Methods: A prospective cohort study included 81 patients younger than 2 years with symptoms suggestive of CD, who all completed the diagnostic procedure based on 3 small bowel biopsies. According to the finding of the third biopsy, patients were divided into group A—CD confirmed (N = 44), and group B—CD not confirmed, after the gluten challenge (N = 37).

Results: At the time of the first biopsy, total villous atrophy (Marsh IIIc) was found more often in group A than in group B (77% vs 27%, P < 0.01). Also, all of the studied antibodies were more frequently positive in group A than in group B (P < 0.01 for all of the tested antibodies). Positive anti-endomysial antibodies and Marsh IIIc finding were the best discriminators between the group A and the group B and considerably contributed to the prediction of CD.

Conclusions: The second and the third biopsies (before and after the gluten challenge) may also be avoided when diagnosing CD in children younger than 2 years provided that the child, at the time of presentation, has positive anti-endomysial antibodies and Marsh IIIc on the small bowel biopsy. A gluten challenge should be still considered in all other children younger than 2 years.

Author Information

Referral Centre for Paediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia.

Address correspondence and reprint requests to Zrinjka Mišak, MD, PhD, Referral Centre for Paediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University Hospital Centre “Sisters of Mercy,” Klaićeva 16, Zagreb, Croatia (e-mail: zrinjka.misak@gmail.com).

Received 6 March, 2012

Accepted 14 August, 2012

The authors report no conflicts of interest.

Copyright 2013 by ESPGHAN and NASPGHAN