Over the last year, several European societies with an interest in coeliac disease and other gluten-related disorders have published and updated guidelines for use in clinical practice. This article looks to provide a brief overview of the guidelines and highlight the updates that have been made.
The European Society for the Study of Coeliac Disease (ESSCD) has published a guideline for coeliac disease and other gluten-related disorders. This provides recommendations for the management of these conditions in both adults and children. Diagnosis and treatment of coeliac disease is covered with recognition that slow responsiveness can be common particularly in those diagnosed in adulthood. Persistent or recurring symptoms require a review of the original diagnosis, exclusion of alternative diagnoses, confirmation of adherence to diet and follow-up biopsy. Evaluation to exclude complications should also be performed.
The guideline also covers other gluten-related disorders including dermatitis herpetiformis, non-coeliac gluten sensitivity and neurological manifestations of gluten sensitivity such as gluten ataxia.
The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) has updated the 2012 guideline for diagnosing coeliac disease in the paediatric population. The 2019 update features two key changes to recommendations:
- Genetic testing is no longer required in children with high antibody levels. The updated guideline states that for children whose blood tests show a level of IgA tissue transglutaminase (tTG) >10 x the upper limit of normal, a biopsy may not be needed to confirm a diagnosis. However, a positive endomysial antibody (EMA) test is required to confirm diagnosis in a no-biopsy approach. For children with IgA deficiency a no-biopsy approach should not be offered
- A no-biopsy approach can be offered to children with high levels of antibodies but who are asymptomatic. This approach can be adopted based on shared decision making between parents/child and the healthcare professional team
It is important a diagnosis of coeliac disease in children is made in secondary care.
Following this update to the ESPGHAN guideline, the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) and Coeliac UK guideline will also be updated.