Department of Paediatrics, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, the Netherlands.
Clinical Research Center, Rijnstate Hospital, Arnhem, the Netherlands.
Eur J Pediatr. 2024 Oct;183(10):4253-4258. doi: 10.1007/s00431-024-05686-1. Epub 2024 Jul 19.
Critics of the ESPGHAN guidelines on CD question the acceptance of the no-biopsy policy by patients and parents against the backdrop of a lifelong diagnosis. The aim of this study was to investigate the impact of the no-biopsy approach on dietary adherence and health-related quality of life (HRQOL). In this retrospective cohort study, patients ≤ 18 years diagnosed with CD between 2007 and 2017 were sent two questionnaires: a dietary interview and a CD-specific HRQOL questionnaire (CDDUX). Included patients were divided into group A (with biopsies <2012), B (with biopsies >2012) and C (without biopsies >2012). Fisher exact test and ANOVA were used to analyze the impact of the new diagnostic strategy. Forty-seven percent (82/173 patients) consented to participate in the study. Of them, 63% had a biopsy-confirmed diagnosis (40% before 2012 (group A), 23% after 2012 (group B)), and 37% were diagnosed without biopsies (group C). Dietary compliance was similar in all groups (p = 0.67). Group A scored significantly better on the subscale 'Having CD' compared to both groups diagnosed after 2012 (p = 0.003). Group A and group C seemed to score better on the total CDDUCX score when compared to group B (86 and 80% versus 61% respectively, p = 0.13). This was also observed within the subscale Diet; Group A and C scored significantly better than group B (62 and 72% versus 39% respectively, p = 0.09).
Omitting duodenal biopsies in the diagnostic approach of our CD cohort had no adverse effect on dietary adherence and HRQOL.
• Since the publication of the ESPGHAN guideline of 2012, duodenal biopsies are no longer obligatory in the diagnostic approach of CD if IgA-antibodies for transglutaminase 2 are ≥10× ULN, endomysial antibodies are positive in a second blood sample and the patient/family agrees with the no-biopsy approach. • Literature on the effect of the no-biopsy approach on dietary adherence and HRQOL is scarce.
• Omitting duodenal biopsies does not influence dietary adherence and quality of life. • In our cohort, lower quality of life measured with the CDDUX subscale 'Having CD' is more likely to be related to shorter disease duration than to the diagnostic approach.
研究不进行活检的方法对饮食依从性和健康相关生活质量（HRQOL）的影响。
在这项回顾性队列研究中，我们向 2007 年至 2017 年间诊断为 CD 的≤18 岁患者发送了两份问卷：饮食访谈和 CD 特异性 HRQOL 问卷（CDDUX）。纳入的患者分为 A 组（活检<2012 年）、B 组（活检>2012 年）和 C 组（活检>2012 年）。采用 Fisher 确切检验和 ANOVA 分析新诊断策略的影响。
47%（82/173 例患者）同意参与研究。其中，63%的患者活检确诊（2012 年前 40%（A 组），2012 年后 23%（B 组）），37%的患者未经活检诊断（C 组）。各组的饮食依从性相似（p=0.67）。与 2012 年后诊断的两组相比，A 组在“患有 CD”亚量表上的评分显著更好（p=0.003）。与 B 组相比，A 组和 C 组在总 CDDUCX 评分上的评分似乎更好（分别为 86%和 80%对 61%，p=0.13）。在饮食亚量表中也观察到了同样的情况；A 组和 C 组的评分明显优于 B 组（分别为 62%和 72%对 39%，p=0.09）。
在我们的 CD 队列中，在诊断方法中省略十二指肠活检对饮食依从性和 HRQOL 没有不良影响。
