title: Diagnosis of coeliac disease in children younger than 2 years.
abstract: OBJECTIVE
  To diagnose coeliac disease (CD) in children younger than 2 years, the old ESPGHAN criteria based on 3 small bowel biopsies were recommended until recently. The aim of the present study was to investigate the applicability of only 1 small intestinal biopsy plus positive serology for the diagnosis of CD in children younger than 2 years.
  
  
  METHODS
  A prospective cohort study included 81 patients younger than 2 years with symptoms suggestive of CD, who all completed the diagnostic procedure based on 3 small bowel biopsies. According to the finding of the third biopsy, patients were divided into group A-CD confirmed (N = 44), and group B-CD not confirmed, after the gluten challenge (N = 37).
  
  
  RESULTS
  At the time of the first biopsy, total villous atrophy (Marsh IIIc) was found more often in group A than in group B (77% vs 27%, P < 0.01). Also, all of the studied antibodies were more frequently positive in group A than in group B (P < 0.01 for all of the tested antibodies). Positive anti-endomysial antibodies and Marsh IIIc finding were the best discriminators between the group A and the group B and considerably contributed to the prediction of CD.
  
  
  CONCLUSIONS
  The second and the third biopsies (before and after the gluten challenge) may also be avoided when diagnosing CD in children younger than 2 years provided that the child, at the time of presentation, has positive anti-endomysial antibodies and Marsh IIIc on the small bowel biopsy. A gluten challenge should be still considered in all other children younger than 2 years.
authors: Referral Centre for Paediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia. zrinjka.misak@gmail.com
authors: Zrinjka
authors: Z
authors: Mišak
authors: Iva
authors: I
authors: Hojsak
authors: Oleg
authors: O
authors: Jadrešin
authors: Alemka Jaklin
authors: AJ
authors: Kekez
authors: Slaven
authors: S
authors: Abdović
authors: Sanja
authors: S
authors: Kolaček
mesh_terms: D001323:Autoantibodies / Q000097:blood*; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000473:pathology*; D008297:Male
chemical_list: D001323:Autoantibodies