Department of Pediatrics, Yeovil District Hospital, Yeovil, United Kingdom.
Medical School, Cardiff University, Cardiff, Wales.
J Pediatr Gastroenterol Nutr. 2021 Jun 1;72(6):e149-e153. doi: 10.1097/MPG.0000000000003126.
The 2012 European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines on celiac disease (CD) recommended a no-biopsy pathway (NBP) for symptomatic children with high immunoglobin A (IgA)-based anti-tissue transglutaminase (TGA-IgA) titers, positive anti-endomysial antibody and human leukocyte antigen (HLA)-DQ2/DQ8 status. We aimed to understand variations in practice amongst specialist pediatric gastroenterology centers (SPGIC) in the United Kingdom (UK).
A survey questionnaire was sent to all UK SPGIC (n = 29) providing endoscopy services for CD diagnosis. It was divided into four main subgroups: analyzing diagnosis of CD through adherence to the ESPGHAN (2012) guidelines, post-diagnosis care and long-term follow-up and discharge from pediatric services.
All 29 responded. NBP was implemented in 28 of 29 centers. Five of 29 centers had already stopped HLA-DQ2/DQ8 testing for NBP diagnosis. Twenty six of 29 centers were performing endoscopy on screening-identified children (mostly asymptomatic, "at-risk" patients). Diagnosis was communicated by a doctor in 65% SPGIC (n = 19). Most centers (n = 23) waited 6-12 months post-diagnosis to start gluten-free oats. Routine vitamin D supplementation was commenced by 4 of 29 centers. All centers repeated TGA-IgA to assess normalization but at varying times post-GFD. Follow-up was with a combination of doctors/dieticians (n = 26). Eleven of 29 centers discharged their patient to primary care.
There was excellent uptake of ESPGHAN guidelines (2012) in the UK and adherence to guidelines is generally good. Despite published evidence and pragmatic advice from the British Society of Paediatric Gastroenterology Hepatology and Nutrition and National Institute for Health and Care Excellence, significant differences remain in diagnostic and ongoing management practice and are opportunities for research and directive evidence-based follow-up guidance.
2012 年欧洲儿童胃肠病学、肝病学和营养学学会（ESPGHAN）的乳糜泻（CD）指南建议对高免疫球蛋白 A（IgA）基于抗组织转谷氨酰胺酶（TGA-IgA）滴度、抗内膜抗体阳性和人类白细胞抗原（HLA）-DQ2/DQ8 状态的有症状儿童采用无活检途径（NBP）。我们旨在了解英国（UK）专科儿科胃肠病学中心（SPGIC）之间的实践差异。
向所有为 CD 诊断提供内镜服务的英国 SPGIC（n=29）发送了一份调查问卷调查表。它分为四个主要部分：通过遵守 ESPGHAN（2012）指南分析 CD 的诊断、诊断后的护理和长期随访以及从儿科服务中出院。
29 个中心全部回复。28 个中心实施了 NBP。5 个中心已停止 HLA-DQ2/DQ8 检测用于 NBP 诊断。26 个中心对筛查确定的儿童（大多为无症状的“高危”患者）进行内镜检查。65%的 SPGIC（n=19）由医生传达诊断。大多数中心（n=23）在诊断后等待 6-12 个月开始无麸质燕麦。4 个中心开始常规补充维生素 D。所有中心均重复 TGA-IgA 以评估正常化，但在 GFD 后时间不同。随访由医生/营养师（n=26）共同进行。29 个中心中的 11 个将患者转至初级保健。
英国很好地采用了 ESPGHAN 指南（2012），并且总体上对指南的遵循情况良好。尽管有英国儿科学胃肠病学、肝病学和营养学学会和国家卫生与保健卓越研究所的发表证据和务实建议，但在诊断和持续管理实践中仍存在显著差异，这为研究和基于指令的循证随访指南提供了机会。
