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.

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

Zobrazit více v PubMed

J Pediatr Gastroenterol Nutr. 2010 Feb;50(2):140-6 PubMed

Aliment Pharmacol Ther. 2003 Jun 1;17(11):1415-23 PubMed

J Pediatr Gastroenterol Nutr. 2013 Mar;56(3):251-6 PubMed

Clin Gastroenterol Hepatol. 2007 May;5(5):567-73 PubMed

J Clin Gastroenterol. 2008 Mar;42(3):256-60 PubMed

Gastroenterology. 2005 Apr;128(4 Suppl 1):S25-32 PubMed

Eur J Gastroenterol Hepatol. 1999 Oct;11(10):1185-94 PubMed

Pediatrics. 2005 May;115(5):1341-6 PubMed

Acta Paediatr. 2000 Dec;89(12):1426-30 PubMed

J Pediatr Gastroenterol Nutr. 2013 Feb;56(2):201-5 PubMed

Nat Med. 1997 Jul;3(7):797-801 PubMed

Arch Dis Child. 1990 Aug;65(8):909-11 PubMed

Tissue Antigens. 2004 Jun;63(6):562-7 PubMed

Aliment Pharmacol Ther. 2006 Aug 1;24(3):541-52 PubMed

Acta Paediatr. 1995 Mar;84(3):294-8 PubMed

J Pediatr Gastroenterol Nutr. 2013 Mar;56(3):241 PubMed

J Pediatr. 2010 Sep;157(3):373-80, 380.e1 PubMed

J Pediatr Gastroenterol Nutr. 2012 Feb;54(2):229-41 PubMed

J Clin Gastroenterol. 2003 Mar;36(3):219-21 PubMed

J Pediatr Gastroenterol Nutr. 2012 Jan;54(1):136-60 PubMed

Arch Dis Child. 1990 Oct;65(10):1137-41 PubMed

J Pediatr. 1999 Feb;134(2):166-71 PubMed

The Pros and Cons of Using Oat in a Gluten-Free Diet for Celiac Patients