Marzo 2016 - Volume XXXV - numero 3
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1Scuola di Specializzazione in Pediatria, Università di Trieste
2IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
Indirizzo per corrispondenza: elisa.benelli@gmail.com
Key words: Coeliac disease, Diagnosis, Biopsy, IgA anti-transglutaminase
The aim of the present prospective study is to evaluate the clinical consequences of the last ESPGHAN and BSPGHAN guidelines for the diagnosis of Coeliac Disease (CD). All children (aged 0-18 years) diagnosed with CD from January 2011 to May 2014 at the IRCCS Burlo Garofolo of Trieste (Italy) were prospectively enrolled. Children diagnosed without a duodenal biopsy (Group 1) were matched for sex, age, and year of diagnosis to a sample of children diagnosed with a duodenal biopsy (Group 2). All patients were put on Gluten Free Diet (GFD) and followed-up for clinical condition, BMI, and laboratory tests (haemoglobin, serum anti-transglutaminase IgA antibodies) at six months and every year since diagnosis (median follow-up: 1.9 years). Adherence to GFD and quality of life of children were assessed through validated questionnaires. 51 out of 468 (11%) patients were diagnosed without a duodenal biopsy (Group 1; median age 2.1 years) and matched to 92 patients diagnosed with a biopsy (Group 2; median age 2.4 years). At the end of the follow-up the two groups resulted statistically comparable for clinical and nutritional status, serum anti-transglutaminase IgA antibodies titres, quality of life, adherence to GFD, and number of supplementary post-diagnosis medical consultations. The diagnosis of CD can be safely performed without a duodenal biopsy at least in 11% of cases. At least during a medium-term follow-up, this approach has no negative consequence on clinical remission, adherence to diet, and quality of children’s lives.
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1Clinica Pediatrica, IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
2Department of Paediatrics, University of Debrecen Medical School, Hungary
3Tampere Centre for Child Health Research, School of Medicine, University of Tampere
and Tampere University Hospital, Tampere, Finland
4Anatomia Patologica, Spedali Civili, Brescia
5Università di Trieste
Indirizzo per corrispondenza: deleo.luigina@libero.it
Key words: Coeliac disease, Intestinal deposits of IgA anti-transglutaminase
The serum anti-transglutaminase antibodies are the immunological markers for coeliac disease diagnosis. These autoantibodies are synthesized by B-lymphocytes at the intestinal level and their presence in the form of intestinal deposits is a constant feature in the different clinical entities in which coeliac disease is classified: classical, silent, and potential. These intestinal autoantibodies are the first gluten dependent inflammatory markers and they appear before both the intestinal damage and the serum anti-transglutaminase antibodies. The anti-transglutaminase deposits should be looked for to confirm or exclude the diagnosis of coeliac disease when the clinical and immunological features are incomplete or in asymptomatic at risk patients.
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