Abstract
Background
Despite a well-established diagnostic algorithm for celiac disease, it remains unclear
whether prescriptions for celiac serological tests comply with the current pediatric
guidelines.
Aim
To analyze the appropriateness of test prescription in children investigated for celiac
disease in Italy, compared to the current European pediatric guidelines.
Methods
All children who had performed a first evaluation for celiac disease were prospectively
enrolled. Prescribed tests and related indications for testing were recorded, and
compared to the European pediatric guidelines.
Results
Overall, 202 children were enrolled (females 59%, mean age 7.1 years ±4.1) in two
centers. The reasons for celiac disease testing were typical, atypical symptoms or
celiac disease-associated conditions in 46.5%, 49%, and 4.5% of cases, respectively.
First-line tests were IgA and IgG anti-transglutaminase antibodies in 88.1% and 29.7%
of children, IgA and IgG anti-deamidated gliadin peptide antibodies in 43% and 47%,
IgA and IgG anti native gliadin in 15.8%, IgA anti-endomysium antibodies in 44.5%,
HLA predisposing genes in 10% of patients. Test redundancy was very common, and the
current diagnostic guidelines were correctly followed only in 23/202 patients (11.4%).
Conclusions
Diagnostic European guidelines for celiac disease screening are often disregarded
in Italy. Intervention to implement adherence to these guidelines is needed, with
the aim of improving resource utilization, and quality of patient care.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Celiac disease.N Engl J Med. 2012; 367: 2419-2426
- Celiac disease and nonceliac gluten sensitivity: a review.JAMA. 2017; 318: 647-656
- Antibodies to deamidated gliadin peptide in diagnosis of celiac disease in children.J Pediatr Gastroenterol Nutr. 2015; 60: 626-631
- Natural history of antibodies to deamidated gliadin peptides and transglutaminase in early childhood celiac disease.J Pediatr Gastroenterol Nutr. 2007; 45: 293-300
- European society for pediatric gastroenterology, hepatology, and nutrition guidelines for the diagnosis of coeliac disease.J Pediatr Gastroenterol Nutr. 2012; 54: 136-160
- Accuracy in diagnosis of celiac disease without biopsies in clinical practice.Gastroenterology. 2017; 153: 924-935
- Are ESPGHAN “biopsy-sparing” guidelines for celiac disease also suitable for asymptomatic patients?.Am J Gastroenterol. 2015; 110: 1485-1489
- Update on serologic testing in celiac disease.Am J Gastroenterol. 2010; 105: 2520-2524
- Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report.J Pediatr Gastroenterol Nutr. 2012; 54: 229-241
- Accuracy of testing for antibodies to synthetic gliadin-related peptides in celiac disease.Clin Gastroenterol Hepatol. 2006; 4: 1112-1117
- Antibodies against deamidated gliadin peptides and tissue transglutaminase for diagnosis of pediatric celiac disease.J Pediatr Gastroenterol Nutr. 2012; 55: 695-700
- In screening for celiac disease, deamidated gliadin rarely predicts disease when tissue transglutaminase is normal.J Pediatr Gastroenterol Nutr. 2019; 68: 20-25
- AGA Institute Medical position statement on the diagnosis and management of celiac disease.Gastroenterology. 2006; 131: 1977-1980
- Repeated screening is necessary for detection of celiac disease but can be restricted to at genetic risk birth cohorts.J Pediatr Gastroenterol Nutr. 2016; 62: 271-275
- Big differences in primary care celiac disease serological markers request in Spain.Biochem Med. 2017; 27: 231-236
- Celiac disease diagnosis: impact of guidelines on medical prescription in France.J Dig Dis. 2014; 15: 435-443
Article info
Publication history
Published online: August 03, 2019
Accepted:
June 18,
2019
Received:
April 25,
2019
Identification
Copyright
© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
