Department of Paediatric Gastroenterology, Starship Children's Health.
Auckland District Health Board Research Office.
J Pediatr Gastroenterol Nutr. 2018 Dec;67(6):749-754. doi: 10.1097/MPG.0000000000002065.
The 2012 European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guideline for diagnosis of celiac disease (CD) questioned the requirement for intestinal biopsy to confirm the diagnosis. The guideline recommends that in symptomatic patients with consistent human leukocyte antigen (HLA) subtypes, the diagnostic accuracy of strongly positive serology is sufficient to confirm the diagnosis. We prospectively assessed these guidelines in a "real-life" clinical setting.
One hundred and four children referred for evaluation of possible CD were prospectively recruited. Following informed consent, blood was drawn for serological testing and HLA analysis at upper gastrointestinal endoscopy. Histological findings according to Marsh criteria were correlated with blood results and the accuracy of the guideline analyzed.The study also examined the role of deamidated gliadin peptide (DGP) in the diagnosis of CD.
For symptomatic patients with consistent HLA subtypes, strongly positive serology (as described in the ESPGHAN guidelines) accurately predicted biopsy-proven CD in >95% of cases. DGP was positive in fewer patients than anti-TG2 or EMA. Incorporation of DGP as a second confirmatory serological test in place of EMA was associated with maintained predictive value of guideline, but fewer patients fulfilling criteria for biopsy-free diagnosis.
The ESPGHAN guideline performs well in our population. Adoption of the guideline would reduce the number of patients requiring endoscopy without compromise in diagnostic accuracy. The involvement of pediatric gastroenterological expertise, however, remains key to diagnosis of CD.
2012 年欧洲小儿胃肠病学、肝病学和营养学学会（ESPGHAN）发布的乳糜泻诊断指南对肠活检确认诊断的必要性提出了质疑。该指南建议在具有一致人类白细胞抗原（HLA）亚型的有症状患者中，强阳性血清学的诊断准确性足以确认诊断。我们在“真实”临床环境中前瞻性地评估了这些指南。
104 名因疑似乳糜泻而接受评估的儿童被前瞻性招募。在获得知情同意后，在上消化道内镜检查时采集血液进行血清学检测和 HLA 分析。根据 Marsh 标准进行的组织学发现与血液结果相关，并分析了指南的准确性。该研究还探讨了脱酰胺麦胶肽（DGP）在乳糜泻诊断中的作用。
对于具有一致 HLA 亚型的有症状患者，强阳性血清学（如 ESPGHAN 指南所述）在>95%的情况下准确预测了活检证实的乳糜泻。与抗 TG2 或 EMA 相比，DGP 阳性的患者更少。将 DGP 作为替代 EMA 的第二项确证性血清学检测纳入，与指南保持预测价值相关，但符合无活检诊断标准的患者更少。
ESPGHAN 指南在我们的人群中表现良好。采用该指南可减少需要内镜检查的患者数量，而不会影响诊断准确性。然而，儿科胃肠病学专业知识的参与仍然是乳糜泻诊断的关键。
