New research and data regarding celiac disease diagnosis is bringing changes. There will no longer be the need for an endoscopic examination under general anesthesia for children making the diagnosis procedure a lot easier for both the young patients and the physicians. After 40 years the duodenal biopsy which was obtained through an endoscopic examination is no longer needed and a blood test is now the preferred screening method for diagnosis. Therefore children with anti-transglutaminase antibodies that are 10 times the normal values will no longer require an endoscopy.
A biopsy still remains necessary for celiac disease diagnosis in adults
The new guidelines have been implemented according to the directions of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition, indicating that children may be diagnosed without an endoscopy examination; however, the endoscopy will still be used to diagnose celiac disease in adults.
“In children with symptoms that are suggestive of celiac disease, where the level of anti-transglutaminase antibodies (anti-TG2) is at least 10 times higher than the normal value, in combination with a positive endomysial antibody (EMA) and in the presence of a genetic test compatible with the diagnosis itself, the diagnosis is certain regardless of the presence of a duodenal biopsy. There is indeed evidence that high levels of anti-TG2 antibodies predict the presence of villous atrophy,” explains Dr. Paoletti Preatoni, Gastroenterologist and Digestive Endoscopist at Humanitas hospital.
What are the advantages of these new guidelines for celiac disease diagnosis in children?
“Surely there will be a lot less discomfort due to the non–invasive diagnostic technique. Do not forget that the age of the initial diagnosis can also be lower, at around 2-3 years.”
In Italy compared to about 180 thousand patients there are an estimated 400 thousand people that are not diagnosed, including 50 thousand children. Moreover, although there are still so few diagnoses, it is estimated that 1 out of 5 diagnoses is wrong. Therefore only 25% of celiac disease cases are diagnosed correctly and receiving treatment.
Is it possible to detect more cases of celiac disease with the new guidelines?
“Many cases of submerged celiac disease could emerge thanks to this new non-invasive diagnostic technique for children as well as from screening family members of people with a celiac disease diagnosis,” – concludes Dr. Preatoni.