European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Coeliac Disease

被引:1870
作者
Husby, S. [1 ]
Koletzko, S. [2 ]
Korponay-Szabo, I. R. [3 ]
Mearin, M. L. [4 ]
Phillips, A. [5 ]
Shamir, R. [6 ]
Troncone, R. [7 ,8 ]
Giersiepen, K. [9 ]
Branski, D.
Catassi, C. [10 ]
Lelgeman, M.
Maki, M. [11 ,12 ]
Ribes-Koninckx, C. [13 ]
Ventura, A. [14 ]
Zimmer, K. P. [15 ]
机构
[1] Odense Univ Hosp, Hans Christian Andersen Childrens Hosp, Odense, Denmark
[2] Univ Munich, Div Paediat Gastroenterol & Hepatol, Dr von Hauner Childrens Hosp, Munich, Germany
[3] Univ Debrecen, Med & Hlth Sci Ctr, Debrecen, Hungary
[4] Leiden Univ, Dept Paediat, Med Ctr, NL-2300 RA Leiden, Netherlands
[5] UCL, Med Sch Paediat & Child Hlth, London WC1E 6BT, England
[6] Tel Aviv Univ, Inst Gastroenterol Nutr & Liver Dis, Schneider Childrens Med Ctr Israel, Sackler Fac Med, Tel Aviv, Israel
[7] Univ Naples Federico II, Dept Paediat, Naples, Italy
[8] Univ Naples Federico II, European Lab Invest Food Induced Dis, Naples, Italy
[9] Univ Bremen, Ctr Social Policy Res, Bremen, Germany
[10] Univ Politecn Marche, Dept Paediat, Marche, Italy
[11] Univ Tampere, Paediat Res Ctr, FIN-33101 Tampere, Finland
[12] Tampere Univ Hosp, Tampere, Finland
[13] La Fe Univ Hosp, Valencia, Spain
[14] Univ Trieste, Dept Paediat, IRCCS Burlo Garofolo, I-34127 Trieste, Italy
[15] Univ Giessen, Dept Gen Paediat & Neonatol, D-35390 Giessen, Germany
关键词
SMALL-BOWEL BIOPSY; DEAMIDATED GLIADIN PEPTIDES; SELECTIVE IGA DEFICIENCY; HUMAN-LEUKOCYTE ANTIGENS; SMALL-INTESTINAL-MUCOSA; DUODENAL BULB BIOPSIES; ALPHA-BETA-HETERODIMER; CLASS-II ALLELES; T-CELL LYMPHOMA; TISSUE TRANSGLUTAMINASE;
D O I
10.1097/MPG.0b013e31821a23d0
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Objective: Diagnostic criteria for coeliac disease (CD) from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESP-GHAN) 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.
引用
收藏
页码:136 / 160
页数:25
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