European society for pediatric gastroenterology, hepatology, and nutrition guidelines for the diagnosis of coeliac disease

S. Husby, S. Koletzko, I. R. Korponay-Szabó, M. L. Mearin, A. Phillips, R. Shamir, R. Troncone, K. Giersiepen, D. Branski, C. Catassi, M. Lelgeman, M. Mäki, C. Ribes-Koninckx, A. Ventura, K. P. Zimmer

Research output: Contribution to journalArticle

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Abstract

Objective: Diagnostic criteria for coeliac disease (CD) from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) were published in 1990. Since then, the autoantigen in CD, tissue transglutaminase, has been identified; the perception of CD has changed from that of a rather uncommon enteropathy to a common multiorgan disease strongly dependent on the haplotypes human leukocyte antigen (HLA)-DQ2 and HLA-DQ8; and CD-specific antibody tests have improved. Methods: A panel of 17 experts defined CD and developed new diagnostic criteria based on the Delphi process. Two groups of patients were defined with different diagnostic approaches to diagnose CD: children with symptoms suggestive of CD (group 1) and asymptomatic children at increased risk for CD (group 2). The 2004 National Institutes of Health/Agency for Healthcare Research and Quality report and a systematic literature search on antibody tests for CD in paediatric patients covering the years 2004 to 2009 was the basis for the evidence-based recommendations on CD-specific antibody testing. Results: In group 1, the diagnosis of CD is based on symptoms, positive serology, and histology that is consistent with CD. If immunoglobulin A anti-tissue transglutaminase type 2 antibody titers are high (>10 times the upper limit of normal), then the option is to diagnose CD without duodenal biopsies by applying a strict protocol with further laboratory tests. In group 2, the diagnosis of CD is based on positive serology and histology. HLA-DQ2 and HLA-DQ8 testing is valuable because CD is unlikely if both haplotypes are negative. Conclusions: The aim of the new guidelines was to achieve a high diagnostic accuracy and to reduce the burden for patients and their families. The performance of these guidelines in clinical practice should be evaluated prospectively.

Original languageEnglish
Pages (from-to)136-160
Number of pages25
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume54
Issue number1
DOIs
Publication statusPublished - Jan 2012

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Nutrition Policy
Celiac Disease
Gastroenterology
Pediatrics
HLA Antigens
Antibodies
Serology
Haplotypes
Histology
Guidelines
Health Services Research
Autoantigens
National Institutes of Health (U.S.)

ASJC Scopus subject areas

  • Gastroenterology
  • Pediatrics, Perinatology, and Child Health

Cite this

European society for pediatric gastroenterology, hepatology, and nutrition guidelines for the diagnosis of coeliac disease. / Husby, S.; Koletzko, S.; Korponay-Szabó, I. R.; Mearin, M. L.; Phillips, A.; Shamir, R.; Troncone, R.; Giersiepen, K.; Branski, D.; Catassi, C.; Lelgeman, M.; Mäki, M.; Ribes-Koninckx, C.; Ventura, A.; Zimmer, K. P.

In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 54, No. 1, 01.2012, p. 136-160.

Research output: Contribution to journalArticle

Husby, S, Koletzko, S, Korponay-Szabó, IR, Mearin, ML, Phillips, A, Shamir, R, Troncone, R, Giersiepen, K, Branski, D, Catassi, C, Lelgeman, M, Mäki, M, Ribes-Koninckx, C, Ventura, A & Zimmer, KP 2012, 'European society for pediatric gastroenterology, hepatology, and nutrition guidelines for the diagnosis of coeliac disease', Journal of Pediatric Gastroenterology and Nutrition, vol. 54, no. 1, pp. 136-160. https://doi.org/10.1097/MPG.0b013e31821a23d0
Husby, S. ; Koletzko, S. ; Korponay-Szabó, I. R. ; Mearin, M. L. ; Phillips, A. ; Shamir, R. ; Troncone, R. ; Giersiepen, K. ; Branski, D. ; Catassi, C. ; Lelgeman, M. ; Mäki, M. ; Ribes-Koninckx, C. ; Ventura, A. ; Zimmer, K. P. / European society for pediatric gastroenterology, hepatology, and nutrition guidelines for the diagnosis of coeliac disease. In: Journal of Pediatric Gastroenterology and Nutrition. 2012 ; Vol. 54, No. 1. pp. 136-160.
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abstract = "Objective: Diagnostic criteria for coeliac disease (CD) from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) were published in 1990. Since then, the autoantigen in CD, tissue transglutaminase, has been identified; the perception of CD has changed from that of a rather uncommon enteropathy to a common multiorgan disease strongly dependent on the haplotypes human leukocyte antigen (HLA)-DQ2 and HLA-DQ8; and CD-specific antibody tests have improved. Methods: A panel of 17 experts defined CD and developed new diagnostic criteria based on the Delphi process. Two groups of patients were defined with different diagnostic approaches to diagnose CD: children with symptoms suggestive of CD (group 1) and asymptomatic children at increased risk for CD (group 2). The 2004 National Institutes of Health/Agency for Healthcare Research and Quality report and a systematic literature search on antibody tests for CD in paediatric patients covering the years 2004 to 2009 was the basis for the evidence-based recommendations on CD-specific antibody testing. Results: In group 1, the diagnosis of CD is based on symptoms, positive serology, and histology that is consistent with CD. If immunoglobulin A anti-tissue transglutaminase type 2 antibody titers are high (>10 times the upper limit of normal), then the option is to diagnose CD without duodenal biopsies by applying a strict protocol with further laboratory tests. In group 2, the diagnosis of CD is based on positive serology and histology. HLA-DQ2 and HLA-DQ8 testing is valuable because CD is unlikely if both haplotypes are negative. Conclusions: The aim of the new guidelines was to achieve a high diagnostic accuracy and to reduce the burden for patients and their families. The performance of these guidelines in clinical practice should be evaluated prospectively.",
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AU - Husby, S.

AU - Koletzko, S.

AU - Korponay-Szabó, I. R.

AU - Mearin, M. L.

AU - Phillips, A.

AU - Shamir, R.

AU - Troncone, R.

AU - Giersiepen, K.

AU - Branski, D.

AU - Catassi, C.

AU - Lelgeman, M.

AU - Mäki, M.

AU - Ribes-Koninckx, C.

AU - Ventura, A.

AU - Zimmer, K. P.

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N2 - Objective: Diagnostic criteria for coeliac disease (CD) from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) were published in 1990. Since then, the autoantigen in CD, tissue transglutaminase, has been identified; the perception of CD has changed from that of a rather uncommon enteropathy to a common multiorgan disease strongly dependent on the haplotypes human leukocyte antigen (HLA)-DQ2 and HLA-DQ8; and CD-specific antibody tests have improved. Methods: A panel of 17 experts defined CD and developed new diagnostic criteria based on the Delphi process. Two groups of patients were defined with different diagnostic approaches to diagnose CD: children with symptoms suggestive of CD (group 1) and asymptomatic children at increased risk for CD (group 2). The 2004 National Institutes of Health/Agency for Healthcare Research and Quality report and a systematic literature search on antibody tests for CD in paediatric patients covering the years 2004 to 2009 was the basis for the evidence-based recommendations on CD-specific antibody testing. Results: In group 1, the diagnosis of CD is based on symptoms, positive serology, and histology that is consistent with CD. If immunoglobulin A anti-tissue transglutaminase type 2 antibody titers are high (>10 times the upper limit of normal), then the option is to diagnose CD without duodenal biopsies by applying a strict protocol with further laboratory tests. In group 2, the diagnosis of CD is based on positive serology and histology. HLA-DQ2 and HLA-DQ8 testing is valuable because CD is unlikely if both haplotypes are negative. Conclusions: The aim of the new guidelines was to achieve a high diagnostic accuracy and to reduce the burden for patients and their families. The performance of these guidelines in clinical practice should be evaluated prospectively.

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