Applicability of the new espghan guidelines for diagnosing coeliac disease in children from resource limited countries

ABSTRACT

Coeliac Disease [CD] is an immune-mediated systemic disorder elicited by the ingestion of gluten. Small-bowel biopsies and histology has been the gold standard for diagnosing CD. The modified ESPGHAN guidelines recommend that in symptomatic children with anti-tissue-Transglutaminase [tTG] titre of > 10 times Upper-Limit-of-Normal [ULN], diagnosis of CD can be made without small-bowel biopsies. However, positive HLA-DQ2/DQ8 serotype and anti-Endomysial Antibodies [EMA] are necessary. Studies from resource-limited countries have demonstrated applicability of the ESPGHAN guidelines for serological diagnosis of CD. CD should not be diagnosed on the basis of a single high tTG-titre. Small-bowel biopsies are necessary for diagnosing CD in asymptomatic children and those with tTG-titre < 10 x ULN. Management of CD needs lifelong gluten free diet