The 2012 European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guideline for diagnosis of celiac disease (CD) questioned the requirement for intestinal biopsy to confirm the diagnosis. The guideline recommends that in symptomatic patients with consistent human leukocyte antigen (HLA) subtypes, the diagnostic accuracy of strongly positive serology is sufficient to confirm the diagnosis. We prospectively assessed these guidelines in a “real-life” clinical setting.
One hundred and four children referred for evaluation of possible CD were prospectively recruited. Following informed consent, blood was drawn for serological testing and HLA analysis at upper gastrointestinal endoscopy. Histological findings according to Marsh criteria were correlated with blood results and the accuracy of the guideline analyzed.
The study also examined the role of deamidated gliadin peptide (DGP) in the diagnosis of CD.
For symptomatic patients with consistent HLA subtypes, strongly positive serology (as described in the ESPGHAN guidelines) accurately predicted biopsy-proven CD in >95% of cases. DGP was positive in fewer patients than anti-TG2 or EMA. Incorporation of DGP as a second confirmatory serological test in place of EMA was associated with maintained predictive value of guideline, but fewer patients fulfilling criteria for biopsy-free diagnosis.
The ESPGHAN guideline performs well in our population. Adoption of the guideline would reduce the number of patients requiring endoscopy without compromise in diagnostic accuracy. The involvement of pediatric gastroenterological expertise, however, remains key to diagnosis of CD.
*Department of Paediatric Gastroenterology, Starship Children's Health
†Auckland District Health Board Research Office
‡Department of Virology & Immunology, LabPLUS
§Department of Clinical Immunology, Auckland City Hospital
||Department of Immunology, Labtests
¶Department of Histopathology, Auckland City Hospital, Auckland, New Zealand.
Address correspondence and reprint requests to Jonathan Bishop, MBChB, Starship Children's Health, Auckland 1023, New Zealand (e-mail: firstname.lastname@example.org).
Received 21 December, 2016
Accepted 5 May, 2018
Peter Reed – statistical support and second author
Paul Austin – laboratory coinvestigator
Miriam Hurst – laboratory coinvestigator
Rohan Ameratunga – laboratory coinvestigator
Alyson Craigie – laboratory coinvestigator
Jeannette McFarlane – laboratory coinvestigator
Simon E Chin – clinical coinvestigator
Stephen M Mouat – clinical coinvestigator and third author
Helen M Evans– clinical coinvestigator and senior author
The authors report no conflicts of interest.