From the Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands.
the Unit of Celiac Disease and Diabetes, Department of Clinical Sciences, Lund University, Lund, Sweden and Unit of Pediatric Gastroenterology, Department. of Pediatrics, Skåne University Hospital, Malmö, Sweden.
J Pediatr Gastroenterol Nutr. 2022 Sep 1;75(3):369-386. doi: 10.1097/MPG.0000000000003540. Epub 2022 Jun 27.
OBJECTIVES: To gather the current evidence and to offer recommendations for follow-up and management. METHODS: The Special Interest Group on Celiac Diseases of the European Society of Paediatric Gastroenterology Hepatology and Nutrition formulated ten questions considered to be essential for follow-up care. A literature search (January 2010-March 2020) was performed in PubMed or Medline. Relevant publications were identified and potentially eligible studies were assessed. Statements and recommendations were developed and discussed by all coauthors. Recommendations were voted upon: joint agreement was set as at least 85%. RESULTS: Publications (n = 2775) were identified and 164 were included. Using evidence or expert opinion, 37 recommendations were formulated on: The need to perform follow-up, its frequency and what should be assessed, how to assess adherence to the gluten-free diet, when to expect catch-up growth, how to treat anemia, how to approach persistent high serum levels of antibodies against tissue-transglutaminase, the indication to perform biopsies, assessment of quality of life, management of children with unclear diagnosis for which a gluten-challenge is indicated, children with associated type 1 diabetes or IgA deficiency, cases of potential celiac disease, which professionals should perform follow-up, how to improve the communication to patients and their parents/caregivers and transition from pediatric to adult health care. CONCLUSIONS: We offer recommendations to improve follow-up of children and adolescents with celiac disease and highlight gaps that should be investigated to further improve management.
目的:收集目前的证据,并提供随访和管理建议。
方法:欧洲儿科学会胃肠病学、肝病学和营养学的乳糜泻专业兴趣小组制定了十个被认为是随访护理所必需的问题。在 PubMed 或 Medline 中进行了文献检索(2010 年 1 月至 2020 年 3 月)。确定了相关出版物,并评估了潜在的合格研究。由所有合著者制定和讨论陈述和建议。建议进行投票:联合协议设定为至少 85%。
结果:确定了出版物(n=2775),并纳入了 164 篇。根据证据或专家意见,就以下方面制定了 37 项建议:进行随访的必要性、随访的频率和应评估哪些内容、如何评估对无麸质饮食的依从性、何时期望赶上生长、如何治疗贫血、如何处理持续高水平的组织转谷氨酰胺酶抗体、进行活检的指征、生活质量评估、对需要进行无麸质饮食挑战的诊断不明确的儿童、伴有 1 型糖尿病或 IgA 缺乏的儿童、潜在乳糜泻病例的管理、应由哪些专业人员进行随访、如何改善与患者及其父母/照顾者的沟通以及从儿科向成人保健的过渡。
结论:我们提供了改善乳糜泻儿童和青少年随访的建议,并强调了需要进一步研究以改善管理的差距。
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