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• W3162795455 abstract "The European Society of Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) non-biopsy criteria used in the diagnosis of paediatric coeliac disease (CD) have become increasingly accepted with studies determining that it accurately predicts CD in >95% of paediatric cases.1, 2 Under the 2020 ESPGHAN criteria, a diagnosis can be made once specific serological conditions are satisfied without routine human leukocyte antigen (HLA) typing.3 Omission of duodenal biopsies raises the concern of missing incidental clinical pathology. Our study aimed to determine the frequency of incidental pathology within an Australian paediatric population with histologically confirmed CD who would have satisfied the 2020 ESPGHAN non-biopsy criteria. We performed a retrospective review of electronic medical and pathology records at a single tertiary centre, Monash Children's Hospital, to identify children satisfying our selection criteria. Our selection criteria consisted of age <18 years, anti-tissue transglutaminase (TTG) IgA >10x upper limit of normal (ULN) and deamidated gliadin peptide (DGP) IgA or IgG >10x ULN. These were all enzyme-linked immunosorbent assay rather than point of care testing. Pathology reports for all eligible patients were subsequently reviewed for incidental pathology. We identified 252 children between 2013 and 2018 who received a histological CD diagnosis, based on Modified Marsh criteria, only those with Marsh Type 3 were included. Only 44 (17.5%) out of 252 met our selection criteria of which 25 were female and 19 male, median ages of 6 and 7 years, respectively. All 44 patients underwent duodenal biopsy with additional oesophageal and gastric biopsies obtained in 12 (27.3%) and 43 (97.7%) children, respectively. It is not our practice to biopsy a normal-looking oesophagus in the assessment of children with suspected CD. A median of 6 duodenal, 2 oesophageal and 2 gastric biopsies were obtained. Incidental pathology was identified in nine (20.5%) out of 44 children, with a total of 10 cases comprising of six lymphocytic gastritis (five females, one male) and four reflux oesophagitis (four females). Lymphocytic gastritis was not deemed as a significant finding due to its association with CD; therefore, only four (9.1%) out of 44 children had potentially significant findings. None of the children with incidental histological abnormalities had abnormal endoscopic findings at endoscopy in either stomach or oesophagus. Although we strived to adhere to the 2020 ESPGHAN non-biopsy criteria,3 we encountered several issues with its implementation in an Australian population. Testing for endomysial antibodies (EMA) is not routinely performed and thus, we included DGP IgG or IgA ≥10x ULN to replicate the requirement of a second positive coeliac serological marker.4 Despite this limitation, our study suggests that significant pathology occurs infrequently within an Australian paediatric population potentially qualifying for the ESPGHAN non-biopsy approach and thus, is safe when applied correctly. Our study found that only 17.5% of the initial study population satisfied our selection criteria, which suggests that many children will still require duodenal biopsies and this is consistent with other Australian studies.4" @default.
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• W3162795455 date "2021-05-10" @default.
• W3162795455 modified "2023-09-26" @default.
• W3162795455 title "Incidental Pathology is Seldom Missed in Children Satisfying the <scp>ESPGHAN</scp> Non‐Biopsy Criteria for the Diagnosis of Coeliac Disease: a Retrospective Single‐Centre Study" @default.
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• W3162795455 doi "https://doi.org/10.1111/jpc.15510" @default.
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