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Evidence Supporting Serology Based Pathway for Diagnosing Coeliac Disease In Asymptomatic Children From High-Risk Groups.

Evidence Supporting Serology Based Pathway for Diagnosing Coeliac Disease In Asymptomatic Children From High-Risk Groups.
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Paul SP, Sandhu BK, Spray CH, Basude D, Ramani P,


Paul SP, Sandhu BK, Spray CH, Basude D, Ramani P, (click to view)

Paul SP, Sandhu BK, Spray CH, Basude D, Ramani P,

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Journal of pediatric gastroenterology and nutrition 2017 09 27() doi 10.1097/MPG.0000000000001757
Abstract
OBJECTIVE
The European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines for diagnosing coeliac disease (CD) in children were modified in 2012. They recommend that in symptomatic children with anti-tissue transglutaminase antibody (anti-tTG) titre of greater than 10-times upper limit of normal (>10xULN) and who have positive anti-endomysial antibody and HLA-DQ2/DQ8 haplotype, the diagnosis of CD can be based on serology. 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 – February 2017 prospective data on anti-tTG titre, age, sex and reason for screening was collected at diagnostic endoscopy on all asymptomatic children being diagnosed with CD. The relationship between modified Marsh-Oberhuber classification histological grading and contemporaneous anti-tTG titres was analysed.

RESULTS
157 asymptomatic children were diagnosed with CD. 84/157 (53.5%) had antitTG >10xULN (normal <10 IU/ml) and 75/84 were from high-risk groups. All 75 had definitive histological evidence (Marsh-Oberhuber 3a-3c) of small bowel enteropathy. 53/84 children had anti-tTG >200IU/ml and total villous atrophy was present in 29/53 (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/child in the United Kingdom.

CONCLUSION
All 75 asymptomatic children from high-risk groups with anti-tTG >10xULN 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.

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