Coeliac Disease (CD) is underdiagnosed due to the varied presentation of clinical signs and symptoms. European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) provides new and updated summary guidance on the diagnosing children and adolescents with CD.
What’s new in the 2020 guidelines?
- For initial testing, the combination of total IgA and IgA class antibodies against transglutaminase 2 (TGA-IgA) is recommended as this is most accurate and cost-effective. EMA-IgA or DGP-IgG need not be tested initially
- The no-biopsy approach for CD diagnosis is confirmed to be safe in children with high TGAIgA values ≥10 times the upper limit of normal with accurate, appropriate tests and positive endomysial antibodies (EMAIgA) in a second serum sample
- Children with positive TGA-IgA but lower titers (Children with positive TGA-IgA but lower titers (<10 times upper limit of normal) should undergo biopsies to decrease the risk of false positive diagnosis.
- HLA testing and presence of symptoms are not obligatory criteria for a serology based diagnosis without biopsies.
You can access the diagnostic algorithm here: https://www.espghan.org/knowledge-center/publications/Clinical-Advice-Guides/2020_New_Guidelines_for_the_Diagnosis_of_Paediatric_Coeliac_Disease