title: Coeliac disease in the ERA of the new ESPGHAN and BSPGHAN guidelines: a prospective cohort study.
abstract: OBJECTIVE
  To evaluate the consequences of the last European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) guidelines for the diagnosis of coeliac disease (CD) by means of a prospective study.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Institute for Maternal and Child Health IRCCS Burlo Garofolo (Trieste, Italy).
  
  
  METHODS
  Children diagnosed with CD without a duodenal biopsy (group 1), following the last ESPGHAN and BSPGHAN guidelines, and children diagnosed with a duodenal biopsy, matched for sex, age and year of diagnosis (group 2), were prospectively enrolled over a 3-year period. All patients were put on a gluten-free diet (GFD) and were followed up for clinical conditions and laboratory testing at 6 months every year since diagnosis (median follow up: 1.9 years).
  
  
  METHODS
  Resolution of symptoms, body mass index, laboratory testing (haemoglobin, anti-transglutaminase IgA), adherence to a GFD, quality of life, and supplementary post-diagnosis medical consultations.
  
  
  RESULTS
  51 out of 468 (11%) patients were diagnosed without a duodenal biopsy (group 1; median age 2.1 years) and matched to 92 patients diagnosed with a biopsy (group 2; median age 2.4 years). At the end of follow-up the two groups were statistically comparable in terms of clinical and nutritional status, anti-transglutaminase IgA antibody titres, quality of life, adherence to a GFD, and number of supplementary medical consultations.
  
  
  CONCLUSIONS
  On the basis of this prospective study, diagnosis of CD can be reliably performed without a duodenal biopsy in approximately 11% of cases. At least during a medium-term follow-up, this approach has no negative consequences relating to clinical remission, adherence to diet, and quality of life of children with CD.
authors.affiliation: Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Benelli
authors.affiliation: Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Carrato
authors.affiliation: Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Martelossi
authors.affiliation: Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ronfani
authors.affiliation: Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy.
authors.forename: Tarcisio
authors.initials: T
authors.lastname: Not
authors.affiliation: Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ventura
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy / Q000276:immunology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000473:pathology; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007223:Infant; D007231:Infant, Newborn; D007558:Italy; D008297:Male; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011788:Quality of Life; D011503:Transglutaminases / Q000276:immunology; D019564:Unnecessary Procedures
chemical_list: D007070:Immunoglobulin A; D011503:Transglutaminases
keywords: anti-transglutaminase IgA; biopsy; coeliac disease; diagnosis