Do kids need a biopsy for coeliac diagnosis?

An algorithm is just as effective for detecting the disease in some children, say researchers

A diagnosis of coeliac disease can be made without histology in a "significant number" of children, researchers in Europe say.

They evaluated the effect of implementing the 2012 European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines and diagnostic algorithm for a coeliac disease diagnosis in 253 children in the Netherlands.

The guideline state that the gold-standard biopsy can be skipped in children who meet specific criteria.

The criteria are:

  • In symptomatic children with immunoglobulin A anti-tissue transglutaminase type 2 antibody titers more than 10 times the upper limit of normal, anti-endomysial antibodies and predisposing genetic markers (HLA DQ2/8), the duodenal biopsy can be omitted.
     
  • In asymptomatic children at increased risk for coeliac disease, the diagnosis is based on positive serology and histology.

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