Paul Siba Prosad, Sandhu Bhupinder Kaur, Spray Christine Helen, Basude Dharamveer, Ramani Pramila
Department of Pediatrics, Torbay Hospital, Torquay.
Department of Pediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol.
J Pediatr Gastroenterol Nutr. 2018 Apr;66(4):641-644. doi: 10.1097/MPG.0000000000001757.
The European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines for diagnosing celiac disease (CD) in children were modified in 2012. They recommend that in symptomatic children with anti-tissue transglutaminase antibody (anti-tTG) titer of >10 times upper limit of normal (>10× ULN) and who have positive anti-endomysial antibody and HLA-DQ2/DQ8 haplotype, the diagnosis of CD can be based on serology. The aim of this study is to establish whether serology-based pathway of the ESPGHAN guidelines could also be reliably applied to asymptomatic children from high-risk groups.
From March 2007 to February 2017, prospective data on anti-tTG titer, age, sex, and reason for screening were collected at diagnostic endoscopy on all asymptomatic children being diagnosed as having CD. The relationship between modified Marsh-Oberhuber classification histological grading and contemporaneous anti-tTG titers was analyzed.
A total of 157 asymptomatic children were diagnosed as having CD. Eighty-four of 157 (53.5%) had antitTG >10× ULN (normal <10 IU/mL) and 75 of 84 were from high-risk groups. All 75 had definitive histological evidence (Marsh-Oberhuber 3a-3c) of small bowel enteropathy. Fifty-three of 84 children had anti-tTG >200 IU/mL and total villous atrophy was present in 29 of 53 (55%). Main reasons for serological screening were: type-1 diabetes mellitus (n = 36) and first-degree relatives with CD (n = 24). Mean age at diagnosis was 8.8 years. Serology-based diagnosis is cost-beneficial by around £1275 per child in the United Kingdom.
All 75 asymptomatic children from high-risk groups with anti-tTG >10× ULN had histology-proven CD. This study provides further evidence that the guidelines for diagnosing CD by the serology-based pathway should be extended to these children.
欧洲儿科胃肠病、肝病和营养学会（ESPGHAN）关于儿童乳糜泻（CD）诊断的指南于2012年进行了修订。指南建议，对于有症状且抗组织转谷氨酰胺酶抗体（抗tTG）滴度>正常上限10倍（>10×ULN）、抗肌内膜抗体阳性且具有HLA - DQ2/DQ8单倍型的儿童，CD的诊断可基于血清学检查。本研究的目的是确定ESPGHAN指南中基于血清学的诊断途径是否也能可靠地应用于高危组无症状儿童。
2007年3月至2017年2月，收集所有诊断为CD的无症状儿童在诊断性内镜检查时的抗tTG滴度、年龄、性别及筛查原因的前瞻性数据。分析改良的Marsh - Oberhuber分类组织学分级与同期抗tTG滴度之间的关系。
共有157例无症状儿童被诊断为CD。157例中有84例（53.5%）抗tTG>10×ULN（正常<10 IU/mL），84例中的75例来自高危组。所有75例均有小肠肠病的确切组织学证据（Marsh - Oberhuber 3a - 3c）。84例儿童中有53例抗tTG>200 IU/mL，53例中的29例（55%）存在全绒毛萎缩。血清学筛查的主要原因是：1型糖尿病（n = 36）和患有CD的一级亲属（n = 24）。诊断时的平均年龄为8.8岁。在英国，基于血清学的诊断对每个儿童而言成本效益约为1275英镑。
所有75例抗tTG>10×ULN的高危组无症状儿童均有组织学证实的CD。本研究提供了进一步的证据，表明基于血清学途径诊断CD的指南应扩展至这些儿童。
