Wallach Thomas, Genta Robert M, Lebwohl Benjamin, Green Peter H R, Reilly Norelle R
*Department of Pediatrics, Division of Pediatric Gastroenterology, University of California San Francisco, San Francisco, CA †University of Texas-Southwestern Medical Center, Dallas, TX ‡Miraca Life Sciences Research Institute, Irving, TX §Department of Medicine, Celiac Disease Center ||Division of Pediatric Gastroenterology, Columbia University College of Physicians and Surgeons, New York, NY.
J Pediatr Gastroenterol Nutr. 2017 Jul;65(1):64-68. doi: 10.1097/MPG.0000000000001574.
Celiac disease (CD) and eosinophilic esophagitis (EoE) are underdiagnosed gastrointestinal conditions, which adversely affect children's health. Previous studies have shown that diagnostic guidelines for CD are not consistently followed in adults. The aims of the present study are to assess the frequency with which endoscopists comply with diagnostic guidelines for CD and EoE in children, and to determine whether an association exists between adherence to biopsy guidelines and disease detection in pediatric patients.
We reviewed pathology reports from 9171 children (ages 0-18) with at least 1 duodenal biopsy, and 8280 children with at least 1 esophageal biopsy, with specimens submitted to a national pathology laboratory. Frequency of adherence to diagnostic guidelines and recommendations for CD and EoE were determined, and the effect of this upon detection of CD and EoE.
Overall, 35% of cases were biopsied according to the 2006 American Gastroenterological Association guidelines for CD diagnosis; 8% were biopsied according to the 2007 American Gastroenterological Association EoE consensus recommendations. Detection of CD and EoE increased with the number of biopsies collected (P for trend in each <0.001). Adherence to diagnostic guidelines was particularly poor among those found to have histologically normal mucosa in both cohorts. The likelihood of CD and EoE diagnosis was significantly associated with adherence to diagnostic guidelines (odds ratio for CD 6.3, 95% confidence interval 4.4-8.9; odds ratio for EoE 2.4, 95% confidence interval 1.9-2.9).
Adherence to established guidelines is poor, and improved guideline adherence is associated with greater disease detection rates for CD and EoE.
乳糜泻（CD）和嗜酸性食管炎（EoE）是诊断不足的胃肠道疾病，对儿童健康有不利影响。既往研究表明，成人中CD的诊断指南并未得到始终如一的遵循。本研究的目的是评估内镜医师对儿童CD和EoE诊断指南的遵循频率，并确定儿科患者活检指南的遵循情况与疾病检出之间是否存在关联。
我们回顾了9171名年龄在0至18岁之间且至少进行过1次十二指肠活检的儿童以及8280名至少进行过1次食管活检的儿童的病理报告，这些标本已提交至一家国家病理实验室。确定了对CD和EoE诊断指南及建议的遵循频率，以及这对CD和EoE检出的影响。
总体而言，35%的病例根据2006年美国胃肠病学会CD诊断指南进行了活检；8%的病例根据2007年美国胃肠病学会EoE共识建议进行了活检。CD和EoE的检出率随活检数量的增加而升高（每组趋势P<0.001）。在两个队列中组织学检查显示黏膜正常的患者中，对诊断指南的遵循情况尤其差。CD和EoE诊断的可能性与遵循诊断指南显著相关（CD的优势比为6.3，95%置信区间为4.4 - 8.9；EoE的优势比为2.4，95%置信区间为1.9 - 2.9）。
对既定指南的遵循情况较差，而提高指南遵循率与CD和EoE更高的疾病检出率相关。
