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Symptom positivity is essential for omitting biopsy in children with suspected celiac disease according to the new ESPGHAN guidelines

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Abstract

The aim of this study was to assess the accuracy of serological tests in combination with clinical symptoms for diagnosing celiac disease (CD) according to the new proposed European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) criteria. We retrospectively assessed children and adolescents aged 16 months –19 years who were examined for suspicion of CD (n = 345). Evaluation of clinical symptoms and the presence of tissue transglutaminase (anti-TG-IgA) and endomysial antibodies (EMA-IgA) as well as intestinal biopsies was performed in all patients. Human leukocyte antigens (HLAs) were not included. Among 345 biopsied children, 213 (62 %) children had anti-TG titers >10 times the upper limit of normal (ULN) and positive EMA antibodies. Ninety-nine (29 %) children also had symptoms suggestive of CD in addition to EMA positivity and elevated titers of anti-TG >10 times the ULN. In patients who were asymptomatic, but positive for EMA, and had anti-TG antibodies >10 times the ULN, the specificity of tests for Marsh 2–3 was only 85 %, while in symptomatic patients with the same antibodies levels, the specificity was 99 %. Conclusion: Our results reveal that intestinal biopsies could be omitted in 28 % of patients when the new ESPGHAN guidelines are applied. Due to high accuracy of serological tests in combination with clinical symptoms for diagnosis of CD, the new guideline seems to be applicable even without the use of HLA testing.

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Acknowledgments

This work was supported by a research grant from the University Hospital Motol (VZ FNM) 64203/6001.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Pediatrics, University Hospital Motol, 2nd Medical School, Charles University, V Úvalu 84, 150 06, Prague 5, Czech Republic

    Jiri Nevoral, Radana Kotalova, Ondrej Hradsky, Vera Valtrova, Kristyna Zarubova & Jiri Bronsky

  2. Institute of Immunology, University Hospital Motol, 2nd Medical School, Charles University, Prague, Czech Republic

    Jan Lastovicka

  3. BIOLAB Praha, s.r.o, Prague 6, Czech Republic

    Eva Neubertova & Marketa Trnkova

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  1. Jiri Nevoral
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  2. Radana Kotalova
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  3. Ondrej Hradsky
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  4. Vera Valtrova
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  5. Kristyna Zarubova
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  9. Jiri Bronsky
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Correspondence to Ondrej Hradsky.

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Nevoral, J., Kotalova, R., Hradsky, O. et al. Symptom positivity is essential for omitting biopsy in children with suspected celiac disease according to the new ESPGHAN guidelines. Eur J Pediatr 173, 497–502 (2014). https://doi.org/10.1007/s00431-013-2215-0

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  • DOI: https://doi.org/10.1007/s00431-013-2215-0

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