[Diagnosis of celiac disease in clinical practice: present and future].

Autor:	Crehuá-Gaudiza E; Sección Gastroenterología y Nutrición Pediátrica, Hospital Clínico Universitario, Valencia, España. Electronic address: elenacrehua@gmail.com., Barrés Fernández A; Sección Gastroenterología y Nutrición Pediátrica, Hospital Clínico Universitario, Valencia, España., Jovaní Casano C; Sección Gastroenterología y Nutrición Pediátrica, Hospital General de Castellón, Castellón de la Plana, España., Latorre Tejerina M; Sección Gastroenterología y Nutrición Pediátrica, Hospital General de Castellón, Castellón de la Plana, España., Largo Blanco EM; Servicio de Pediatría, Consorcio Hospital General Universitario de Valencia, Valencia, España., Moreno Ruiz MA; Servicio de Pediatría, Hospital de Manises, Manises (Valencia), España., Berghezan Suárez A; Servicio de Pediatría, Hospital de Denia, Denia (Alicante), España., García-Peris M; Servicio de Pediatría, Hospital Lluís Alcanyís de Xàtiva, Silla (Valencia), España., Gil Piquer R; Servicio de Pediatría, Hospital Lluís Alcanyís de Xàtiva, Silla (Valencia), España., Coret Sinisterra A; Servicio de Pediatría, Hospital de Sagunto, Sagunto (Valencia), España., Martínez-Barona S; Servicio de Pediatría, Hospital General de Requena, Requena (Valencia), España., Salido-Capilla C; Servicio de Pediatría, Hospital Universitario La Plana, Villarreal (Castellón), España., Requena Fernández MÁ; Servicio de Pediatría, Hospital de Hellín. Calle Juan Ramón Jiménez, Hellín (Albacete), España., Arcos-Machancoses JV; Hospital IMED, Burjassot (Valencia), España., Martínez-Costa C; Sección Gastroenterología y Nutrición Pediátrica, Hospital Clínico Universitario, Valencia, España.
Jazyk:	Spanish; Castilian
Zdroj:	Anales de pediatria [An Pediatr (Engl Ed)] 2021 Apr; Vol. 94 (4), pp. 223-229. Date of Electronic Publication: 2020 Sep 03.
DOI:	10.1016/j.anpedi.2020.07.008
Abstrakt:	Introduction: European guidelines for the diagnosis of celiac disease (CD) have been updated in 2020. The primary objective was to review the compliance with the diagnostic criteria for CD, according to ESPGHAN 2012. Secondarily, to describe the clinical characteristics of the patients and to assess the changes that would be implied by the application of the new 2020 criteria. Patients and Methods: Retrospective multicenter study in which 10 centers participated. Patients from 0 to 16 years old with a new diagnosis of CD in 2018-2019 were included. Clinical, serological variables and the performance of intestinal biopsy (IB) were collected. Results: 163 patients were included (57% female) with a median age of 7.6 years (SD 4.4). The form of presentation was: 47.8% classical, 30.7% no classical and 21.5% asymptomatic, with differences depending on age. Total IgA and anti-transglutaminase IgA antibodies were performed in all centers as the first diagnostic step. IgA anti-endomysial antibodies (EMA) were performed in 80%, and HLA haplotype in 95%. Of the total, 78 cases (47.9%) met criteria for not performing intestinal biopsy (IB). IB was indicated in the remaining 85 patients, but was not performed in 29 cases (17.8%). The performance of IB was lower in the secondary hospitals than in the tertiary ones (p < 0.05). If we applied the ESPGHAN 2020 criteria, we would disregard the HLA study, and 21 more patients would not have required IB (going from 47.9% to 60.7% of the total). Conclusions: Discrepancies are observed in the application of the ESPGHAN 2012 diagnostic criteria due to the different accessibility to EMA and endoscopic IB in secondary centers. With the ESPGHAN-2020 criteria, around 60% of patients will be able to be diagnosed without IB, provided that the determination of EMA is ensured. (Copyright © 2020. Publicado por Elsevier España, S.L.U.)
Databáze:	MEDLINE
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