Department of Pediatrics, Università Politecnica delle Marche, Ancona, Italy.
Department of Pediatrics, University Hospital of Salerno, Salerno, Italy.
Dig Liver Dis. 2019 Nov;51(11):1547-1550. doi: 10.1016/j.dld.2019.06.016. Epub 2019 Aug 3.
Despite a well-established diagnostic algorithm for celiac disease, it remains unclear whether prescriptions for celiac serological tests comply with the current pediatric guidelines.
To analyze the appropriateness of test prescription in children investigated for celiac disease in Italy, compared to the current European pediatric guidelines.
All children who had performed a first evaluation for celiac disease were prospectively enrolled. Prescribed tests and related indications for testing were recorded, and compared to the European pediatric guidelines.
Overall, 202 children were enrolled (females 59%, mean age 7.1 years ±4.1) in two centers. The reasons for celiac disease testing were typical, atypical symptoms or celiac disease-associated conditions in 46.5%, 49%, and 4.5% of cases, respectively. First-line tests were IgA and IgG anti-transglutaminase antibodies in 88.1% and 29.7% of children, IgA and IgG anti-deamidated gliadin peptide antibodies in 43% and 47%, IgA and IgG anti native gliadin in 15.8%, IgA anti-endomysium antibodies in 44.5%, HLA predisposing genes in 10% of patients. Test redundancy was very common, and the current diagnostic guidelines were correctly followed only in 23/202 patients (11.4%).
Diagnostic European guidelines for celiac disease screening are often disregarded in Italy. Intervention to implement adherence to these guidelines is needed, with the aim of improving resource utilization, and quality of patient care.
尽管针对乳糜泻已有成熟的诊断算法，但目前仍不清楚针对乳糜泻进行的血清学检测是否符合现行儿科指南。
分析意大利疑似乳糜泻患儿的检测处方是否符合现行欧洲儿科指南，以评估检测的适宜性。
前瞻性纳入所有接受乳糜泻初筛的患儿。记录检测的处方和相关适应证，并与欧洲儿科指南进行比较。
共纳入来自两个中心的 202 名患儿（女性占 59%，平均年龄为 7.1 ±4.1 岁）。乳糜泻检测的原因分别为典型、不典型症状和乳糜泻相关疾病，占比分别为 46.5%、49%和 4.5%。一线检测分别为 88.1%和 29.7%的患儿行 IgA 和 IgG 抗转谷氨酰胺酶抗体检测、43%和 47%的患儿行 IgA 和 IgG 抗脱酰胺麦胶蛋白肽抗体检测、15.8%的患儿行 IgA 和 IgG 抗天然麦胶蛋白抗体检测、44.5%的患儿行 IgA 抗内膜抗体检测、10%的患儿行 HLA 易感基因检测。检测的冗余非常常见，仅 23/202 例（11.4%）患儿正确遵循了现行诊断指南。
意大利在乳糜泻的筛查中经常忽视欧洲的诊断指南。需要采取干预措施来实施对这些指南的依从性，以提高资源利用效率，并改善患者的医疗质量。
