@article {1857, title = {Accuracy of diagnostic antibody tests for coeliac disease in children: summary of an evidence report.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {54}, year = {2012}, month = {2012 Feb}, pages = {229-41}, abstract = {

OBJECTIVE: The aim of this study was to summarise the evidence from 2004 to September 2009 on the performance of laboratory-based serological and point of care (POC) tests for diagnosing coeliac disease (CD) in children using histology as reference standard.

PATIENTS AND METHODS: We searched MEDLINE and EMBASE for studies reporting on children for tests based on IgA and IgG anti-gliadin (AGA), endomysial (EmA), anti-transglutaminase-2 (TG2), and anti-deamidated gliadin peptides (DGP) antibodies or POC tests. For inclusion, histological analysis of duodenal biopsies and sensitivity and specificity for index tests had to be reported. Data were pooled and summary measures calculated for sensitivity, specificity, positive and negative likelihood ratios ("LR+", "LR-"), and diagnostic odds ratios (DOR). In case of elevated statistical heterogeneity, studies reaching 90\% sensitivity or specificity were reported.

RESULTS: A total of 2510 articles were reviewed; 16 entered meta-analysis, reporting on 3110 patients (1876 with CD, 1234 without CD). For IgA-EmA, sensitivity was >=90\% in 7/11 studies and pooled specificity 98.2\%. For IgA-anti-TG2, 11/15 studies yielded sensitivities >=90\% and 13/15 specificities >=90\%. For IgA-DGP, sensitivity ranged between 80.7\% and 95.1\% (specificity 86.3\%-93.1\%); for IgG-DGP between 80.1\% and 98.6\% (specificity 86.0-96.9\%). IgA-EmA had the highest pooled DOR (554) and LR+ (31.8) for a laboratory test, followed by IgA-anti-TG2, IgG-DGP, IgA-DGP and IgA-AGA. POC tests showed a pooled sensitivity of 96.4\% for IgA-TG2 (specificity 97.7\%).

CONCLUSIONS: IgA-EmA and IgA-anti-TG2 tests appear highly accurate to diagnose CD. IgG-anti-DGP tests may help in excluding CD. IgA-AGA and IgA-DGP tests show inferior accuracy. POC tests may achieve high accuracy in the hands of experienced readers, but IgA-anti-TG2/EmA were superior.

}, keywords = {Autoantibodies, Biological Markers, Celiac Disease, Child, Gliadin, GTP-Binding Proteins, Humans, Immunoglobulin A, Immunoglobulin G, Point-of-Care Systems, Sensitivity and Specificity, Transglutaminases}, issn = {1536-4801}, doi = {10.1097/MPG.0b013e318216f2e5}, author = {Giersiepen, Klaus and Lelgemann, Monika and Stuhldreher, Nina and Ronfani, Luca and Husby, Steffen and Koletzko, Sibylle and Korponay-Szab{\'o}, Ilma R} } @article {1774, title = {Coeliac disease diagnosis: ESPGHAN 1990 criteria or need for a change? Results of a questionnaire.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {54}, year = {2012}, month = {2012 Jan}, pages = {15-9}, abstract = {

BACKGROUND AND OBJECTIVES: A revision of criteria for diagnosing coeliac disease (CD) is being conducted by The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). In parallel, we have performed a survey aimed to evaluate present practices for CD among paediatric gastroenterologists and to learn their views on the need for modification of present criteria for CD diagnosis.

PATIENTS AND METHODS: Questionnaires were distributed to experienced paediatric gastroenterologists (ESPGHAN members) via the Internet.

RESULTS: Overall, 95 valid questionnaires were available for analysis, pertaining to 28 different countries, with the majority of responders treating patients with CD for >15 years. Only about 12\% of the responders comply with present criteria, noncompliance being related mainly to the challenge policy. Approximately 90\% request a revision and modification of the present criteria. Forty-four percent want to omit the small bowel biopsy in symptomatic children with positive anti-tissue transglutaminase immunoglobulin (Ig) A or endomysial IgA antibodies, especially if they are DQ2/DQ8 positive. For silent cases detected by screening with convincingly positive anti-tissue transglutaminase IgA or EMA IgA, about 30\% consider that no small bowel biopsy should be required in selected cases. Adding human leukocyte antigen typing in the diagnostic workup was asked for by 42\% of the responders. As for gluten challenge, a new policy is advocated restricting its obligation to cases whenever the diagnosis is doubtful or unclear.

CONCLUSIONS: Based on these opinions, revision of the ESPGHAN criteria for diagnosing CD is urgently needed.

}, keywords = {Adolescent, Adult, Biopsy, Celiac Disease, Child, Child, Preschool, Glutens, Guideline Adherence, Guidelines as Topic, Health Care Surveys, Humans, Immunoglobulin A, Intestine, Small, Physician{\textquoteright}s Practice Patterns, Questionnaires, Societies, Medical, Transglutaminases, Young Adult}, issn = {1536-4801}, doi = {10.1097/MPG.0b013e31822a00bb}, author = {Ribes-Koninckx, C and Mearin, M L and Korponay-Szab{\'o}, I R and Shamir, R and Husby, S and Ventura, A and Branski, D and Catassi, C and Koletzko, S and M{\"a}ki, M and Troncone, R and Zimmer, K P} } @article {1843, title = {European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {54}, year = {2012}, month = {2012 Jan}, pages = {136-60}, 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.

}, keywords = {Adolescent, Celiac Disease, Child, Duodenum, HLA-DQ Antigens, Humans, Immunoglobulin A, Transglutaminases}, issn = {1536-4801}, doi = {10.1097/MPG.0b013e31821a23d0}, author = {Husby, S and Koletzko, S and Korponay-Szab{\'o}, I R and Mearin, M L and Phillips, A and Shamir, R and Troncone, R and Giersiepen, K and Branski, D and Catassi, C and Lelgeman, M and M{\"a}ki, M and Ribes-Koninckx, C and Ventura, A and Zimmer, K P} }