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Evidence Supporting Serology-based Pathway for Diagnosing Celiac Disease in Asymptomatic Children From High-risk Groups

Paul, Siba, Prosad*,†; Sandhu, Bhupinder, Kaur†,‡; Spray, Christine, Helen; Basude, Dharamveer; Ramani, Pramila§

Journal of Pediatric Gastroenterology and Nutrition: April 2018 - Volume 66 - Issue 4 - p 641–644
doi: 10.1097/MPG.0000000000001757
Original Articles: Gastroenterology: Celiac Disease

Objective: The European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines for diagnosing celiac disease (CD) in children were modified in 2012. They recommend that in symptomatic children with anti-tissue transglutaminase antibody (anti-tTG) titer of >10 times upper limit of normal (>10× ULN) and who have positive anti-endomysial antibody and HLA-DQ2/DQ8 haplotype, the diagnosis of CD can be based on serology. The aim of this study is to establish whether serology-based pathway of the ESPGHAN guidelines could also be reliably applied to asymptomatic children from high-risk groups.

Methods: From March 2007 to February 2017, prospective data on anti-tTG titer, age, sex, and reason for screening were collected at diagnostic endoscopy on all asymptomatic children being diagnosed as having CD. The relationship between modified Marsh-Oberhuber classification histological grading and contemporaneous anti-tTG titers was analyzed.

Results: A total of 157 asymptomatic children were diagnosed as having CD. Eighty-four of 157 (53.5%) had antitTG >10× ULN (normal <10 IU/mL) and 75 of 84 were from high-risk groups. All 75 had definitive histological evidence (Marsh-Oberhuber 3a-3c) of small bowel enteropathy. Fifty-three of 84 children had anti-tTG >200 IU/mL and total villous atrophy was present in 29 of 53 (55%). Main reasons for serological screening were: type-1 diabetes mellitus (n = 36) and first-degree relatives with CD (n = 24). Mean age at diagnosis was 8.8 years. Serology-based diagnosis is cost-beneficial by around £1275 per child in the United Kingdom.

Conclusions: All 75 asymptomatic children from high-risk groups with anti-tTG >10× ULN had histology-proven CD. This study provides further evidence that the guidelines for diagnosing CD by the serology-based pathway should be extended to these children.

*Department of Pediatrics, Torbay Hospital, Torquay

Department of Pediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol

Joint Centre for Child and Adolescent Health, University of Bristol and University of the West of England

§Department of Paediatric Histopathology, Bristol Royal Hospital for Children, Bristol, UK.

Address correspondence and reprint requests to Dr Siba Prosad Paul, MRCPCH, Consultant Paediatrician, Department of Pediatrics, Torbay Hospital, Lowes Bridge, Torquay TQ2 7AA, UK (e-mail:

Received 30 July, 2017

Accepted 16 September, 2017

The authors report no conflicts of interest.

© 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,