Pediatric Gastroenterology Unit, La Fe University Hospital, Valencia, Spain.
J Pediatr Gastroenterol Nutr. 2012 Jan;54(1):15-9. doi: 10.1097/MPG.0b013e31822a00bb.
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.
Questionnaires were distributed to experienced paediatric gastroenterologists (ESPGHAN members) via the Internet.
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.
Based on these opinions, revision of the ESPGHAN criteria for diagnosing CD is urgently needed.
欧洲儿童胃肠病学、肝病学和营养学学会（ESPGHAN）正在修订乳糜泻（CD）的诊断标准。与此同时，我们进行了一项调查，旨在评估儿科胃肠病学家目前对 CD 的诊治实践，并了解他们对修改目前 CD 诊断标准的看法。
通过互联网向经验丰富的儿科胃肠病学家（ESPGHAN 成员）分发问卷。
共有 95 份有效问卷可供分析，涉及 28 个不同国家，大多数应答者治疗 CD 患者的时间超过 15 年。只有约 12%的应答者符合目前的标准，不符合主要与挑战政策有关。大约 90%的人要求修改和修改目前的标准。44%的人希望在有症状的儿童中，对阳性抗组织转谷氨酰胺酶免疫球蛋白（Ig）A 或内肌内膜 IgA 抗体的儿童，尤其是 DQ2/DQ8 阳性的儿童，省略小肠活检。对于通过令人信服的抗组织转谷氨酰胺酶 IgA 或 EMA IgA 筛查发现的无症状病例，约 30%的人认为在某些情况下无需进行小肠活检。42%的应答者要求在诊断过程中增加人类白细胞抗原分型。至于 gluten challenge，新的政策是主张仅在诊断可疑或不清楚的情况下有义务进行 gluten challenge。
根据这些意见，迫切需要修订 ESPGHAN 诊断 CD 的标准。
