A Retrospective Application of the European Society for Paediatric Gastroenterology Hepatology and Nutrition Guidelines for Diagnosis of Coeliac Disease in New Zealand Children

Abstract

In 2012 the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) published an updated guideline for the diagnosis of Coeliac disease, allowing symptomatic individuals with appropriate serology and HLA genotype to be diagnosed without a small bowel biopsy. This retrospective study aimed to assess the applicability of this guideline to children in New Zealand. Children less than 16 years of age investigated for coeliac disease with small bowel biopsy in Christchurch Hospital between January 2010 and December 2012 were identified. The results of those with tissue transglutaminase IgA (tTG) levels greater than 50 units (10 times upper limit of normal), positive endomysial antibodies and HLA DQ2/DQ8 were used to calculate sensitivity and specificity. Data from 160 children was available: 70 had biopsy-confirmed Coeliac disease, and 90 had negative biopsies. Limited data precluded application of the guidelines to all patients. Using only tTG data, levels above 50 units provided a sensitivity of 67% and a specificity of 92%. Specificity increased to 97% when limited EMA and HLA DQ2/DQ8 data was added. Despite limited data, applying the ESPGHAN guidelines in the Christchurch paediatric population over this period produced a high specificity (97%). Prospective studies are now required to confirm these findings.