Stenhammar L, Hogberg L, Danielsson L et al.How do Swedish paediatric clinics diagnose coeliac disease? Results of a nationwide questionnaire study. Acta Paediatr 95:1495-1497

Department of Paediatrics, Linköping University, Norrköping Hospital, Norrköping, Sweden.
Acta Paediatrica (Impact Factor: 1.67). 12/2006; 95(11):1495-7. DOI: 10.1080/08035250600636552
Source: PubMed


Diagnosis of coeliac disease is based on the demonstration of enteropathy in a small bowel biopsy. Correct diagnosis is of utmost importance, since the need for dietary management is life long, and inadequate treatment may lead to potentially serious complications. The Swedish Working Group for Paediatric Coeliac Disease has published guidelines for the diagnosis of childhood coeliac disease. The present questionnaire was designed in order to create the basis for revision of those guidelines.
In 2004, a nationwide questionnaire concerning current diagnostic routines was sent to all 45 paediatric clinics performing small bowel biopsy. All clinics responded.
All clinics base their diagnosis on small bowel biopsy findings at presentation. Furthermore, in 24 (53%) of the clinics, children with suspected coeliac disease are investigated by small bowel biopsy both at presentation and follow-up while on a gluten-free diet. Eighteen (40%) of the clinics employ a different diagnostic routine for children under 2 y of age than for those older than 2 y. All clinics use coeliac serological testing at various stages of the diagnostic procedure.
All Swedish paediatric clinics perform a small bowel biopsy at presentation in children with suspected coeliac disease, and the majority of clinics perform a second biopsy when the child is on a gluten-free diet. Serological testing is frequently used as a diagnostic aid and in the monitoring of the disease while on a gluten-free diet.

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    • "Although we cannot rule out that our HR is slightly inflated by ascertainment bias, such bias is unlikely to fully explain the positive association seen in this study, as the risk increase remained more than 5 years after CD diagnosis. VA has been the gold standard for CD diagnosis in Sweden since the 1970s (Cavell et al., 1992; Stenhammar et al., 2006), and in a recent survey, 96% of adult gastroenterologists and 100% of pediatricians perform a small intestinal biopsy in at least 90% of patients with suspected CD before assigning a diagnosis of CD (Ludvigsson et al., 2009b). When we reviewed 114 randomly selected patient charts from patients with VA, 108 (95%) had CD. "
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    • "The latter tested negative for antitransglutaminase and antiendomysial antibodies with normal IgA levels, while histology of duodenum did not reveal features of CD. Diagnosis of CD had been performed according to ESPGHAN criteria [15]. Table 2 summarizes clinical features of the studied population. "
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