1 - Department Of Pediatrics, Dr. von Hauner Children's Hospital, LMU Munich, Munich, Germany
2 - Central Lisbon University Hospital Centre, Lisbon, Portugal
3 - ADViSE Research Group. Department of Health Science, European University Miguel de Cervantes, Valladolid, Spain
4 - Nutrition and Obesity Unit. Hospital Recoletas Campo Grande, Valladolid, Spain
5 - Department Of Paediatrics And Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
6 - Human Nutrition, University of Glasgow, Glasgow, United Kingdom
7 - The European Society for Paediatric Gastroenterology Hepatology and Nutrition, Geneva, Switzerland
8 - Department Of Pediatric Gastroenterology, Hepatology, And Nutrition, Emma Children`s Hospital, Amsterdam UMC, Amsterdam, Netherlands
9 - Hepatology, Gastroenterology And Transplantation Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
10 - Referral Center for Pediatric Gastroenterology and Nutrition Children's Hospital Zagreb, Zagreb, Croatia
11 - Department Of Hygiene And Epidemiology, Faculty Of Public Health, Prof. Paraskev Stoyanov Medical University, Varna, Bulgaria
12 - Department Of Pediatrics, Gastroenterology And Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland
- Poster, 56th Annual Meeting of the European Society for Pediatric Gastroenterology, Hepatology and Nutricion (ESPGHAN), Milão, 15-18 de maio 2024
RESUMO:
Objectives and Study: ESPGHAN guidelines* recommend only transglutaminase-antibodies (TGA-IgA) and total IgA for initial coeliac disease (CD) screening, regardless of age. A no-biopsy CD diagnosis is an option with TGA-IgA>10 times upper limit of normal measured with a test fulfilling certain criteria; positive endomysium-antibodies (EMA-IgA) > 1:5 in a 2nd sample confirm CD. Effective and efficient diagnosis is crucial to meet WHO Quality-of-Care (QoC) standards, to optimize resource use and avoid unnecessary costs.
Methods: The QoC initiative of ESPGHAN anonymously surveyed 124 paediatric hospitals in 28 countries about their CD diagnosis practices.
Results: From February to November 2023, 89/124 completed the questionnaires, in 98% a paediatric gastroenterologist (PGI) was involved. When asked whether insufficient knowledge interferes with good QoC for CD patients, 49% of responders selected the general public, 63% primary care providers, 19% non-GI hospital physicians, but none considered PGI. Only 62% adhered to the recommended initial screening protocol limited to total IgA and TGA-IgA; 28% used non-recommended serological markers, including TGA-IgG, DGP-IgA, DPG-IgG, AGA, and EMA, with DGP preferential in children <2 years. A notable 24% were unaware of their lab's TGA-IgA measurement method, and 56% did not know the manufacturer. For EMA-based diagnoses, 91% followed recommendations for nonhistopathological diagnosis, but only 15% correctly diluted EMA to 1:5 if 1:10 dilution was negative. Confirmation of potential CD (positive TGA-IgA with Marsh 0 or 1) were applied by 44% of the responders. In children with negative serology (TGA &EMA) but Marsh 3 on histopathology, 26% of responders incorrectly diagnosed CD as confirmed.
Conclusions: Preliminary survey results identified several shortcomings that may hinder an effective and efficient serological work-up for CD diagnosis. These performance gaps contrast with the self-perceived knowledge of PGIs.