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Coeliac Disease | Conference Report


Coeliac Disease:New approaches to diagnosis,


prevention and practice Organised by Coeliac UK – 3rd February 2012, Royal College of Pathologists, London


Faye Eagle, Publisher, CN Magazines, Complete Media & Marketing


Introduction This conference brought together gastroenterologists, nurses, dietitians, academics, and representatives from coeliac societies across Europe to discuss developments in coeliac disease and the latest research. Welcoming over 100 delegates, Professor David Sanders from the Royal Hallamshire Hospital, Sheffield, started the afternoons proceedings with an overview of the work of Coeliac UK,organisers of this event.


Instigating the presentations, Dr Huw Jenkins from the University Hospital of Wales, Cardiff, spoke on Diagnostic Guidelines for Coeliac Disease (CD) in Childhood. Reflecting back to the 80s, Dr Jenkins provided an historical account of diagnosis amongst this patient group. Dr Jenkins highlighted that diagnosis amongst children in 1988 was uncommon (childhood enteropathy). Referring to data from South Wales, Dr Jenkins stated that, from 1983 to 1989, the average age of diagnosis of CD was four, with 88 per cent presenting with gastrointestinal (GI) symptoms and 12 per cent presenting with no GI symptoms. Comparing this with the 2005 to 2010 data provided a stark contrast: average age of diagnosis was age 13, 41 per cent presented with GI symptoms, 23 per cent presented with no GI symptoms, and 36 per cent were diagnosed by targeted screening. This data highlighted the many changes with regards to diagnosis over the last few decades (e.g. genetic disposure, specific anti-body tests, etc.). With the huge changes over recent decades in mind, in relation to diagnosing CD, Dr Jenkins then went on to provide an introduction to paediatric CD diagnostic criteria from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) – ESPGHAN 2012: Guidelines for the Diagnosis in Children & Adolescents (J Pediatr Gastroenterol Nutr. 2012 Jan; 54(1): 136-60). The new guidelines define CD as:


“CD is an immune-mediated systemic disorder elicited by gluten


and related prolamines in genetically susceptible individuals characterised by the presence of a variable combination of gluten


dependent clinical manifestations, CD-specific antibodies, HLA-DQ2 or DQ8 haplotypes and enteropathy.” Based on the Delphi process, a panel of 17 experts from around


Europe defined CD and developed new diagnostic criteria. The experts defined two groups of patients with different diagnostic approaches to diagnose CD: • Group 1 – Symptomatic (children with symptoms suggestive of CD, e.g. GI symptoms, weight loss, iron deficiency anaemia, poor growth, etc.)


Diagnosis is based on: Symptoms, positive serology, and histology


that is consistent with CD. If immunoglobulin A anti-tissue transglutaminase type 2 antibody titers are high (>10 times the upper limit of normal), then the option is to diagnose CD without duodenal biopsies by applying a strict protocol with further laboratory tests.1 • Group 2 – Asymptomatic (children at an increased risk of CD, e.g. insulin-dependent diabetes mellitus, first degree relatives, auto- immune liver disease, Down’s syndrome, etc.) Diagnosis is based on: Positive serology and histology. HLA-DQ2


and HLA-DQ8 testing is valuable as CD is unlikely if both haplotypes are negative.1 Following Dr Jenkins’ introduction to the new ESPGHAN guidelines, a panel session ensued, discussing the practical implications of ESPGHAN criteria. Varying opinions and concerns were shared from a multiplicity of experts on different elements and implementation of the new guidelines.


CN Focus Vol.4 No.1 April 2012 | 27


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