How do Swedish paediatric clinics diagnose coeliac disease? Results of a nationwide questionnaire study.
OBJECTIVE
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.


METHODS
In 2004, a nationwide questionnaire concerning current diagnostic routines was sent to all 45 paediatric clinics performing small bowel biopsy. All clinics responded.


RESULTS
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.


CONCLUSIONS
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.
Stenhammar
Lars
L
Department of Paediatrics, Linköping University, Norrköping Hospital, Norrköping, Sweden. lars.stenhammar@lio.se
Högberg
Lotta
L
Danielsson
Lars
L
Ascher
Henry
H
Dannaeus
Anders
A
Hernell
Olle
O
Ivarsson
Anneli
A
Lindberg
Eva
E
Lindquist
Bo
B
Nivenius
Kerstin
K
D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy; D002675:Child, Preschool; D005762:Gastroenterology / Q000592:standards*; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000473:pathology; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D013548:Sweden