title: A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease.
abstract: Background. The European Society for Pediatric Gastroenterology, Hepatology and Nutrition endorses serological diagnosis (SD) for pediatric celiac disease (CD). The objective of this study was to pilot SD and to prospectively evaluate gastrointestinal permeability and mucosal inflammation at diagnosis and after one year on the gluten-free diet (GFD). We hypothesized that SD would be associated with similar short term outcomes as ED. Method. Children, 3-17 years of age, referred for possible CD were eligible for SD given aTTG level ≥200 U/mL, confirmed by repeat aTTG and HLA haplotypes. Gastrointestinal permeability, assessed using sugar probes, and inflammation, assessed using fecal calprotectin (FC), at baseline and after one year on a GFD were compared to patients who had ED. Results. Enrolled SD (n = 40) and ED (n = 48) patients had similar demographics. ED and SD groups were not different in baseline lactulose: mannitol ratio (L : M) (0.049 versus 0.034; p = 0.07), fractional excretion of sucrose (%FES; 0.086 versus 0.092; p = 0.44), or fecal calprotectin (FC; 89.6 versus 51.4; p = 0.05). At follow-up, urine permeability improved and was similar between groups, L : M (0.022 versus 0.025; p = 0.55) and %FES (0.040 versus 0.047; p = 0.87) (p > 0.05). FC improved but remained higher in the SD group (37.1 versus 15.9; p = 0.04). Conclusion. Patients on the GFD showed improved intestinal permeability and mucosal inflammation regardless of diagnostic strategy. This prospective study supports that children diagnosed by SD have resolving mucosal disease early after commencing a GFD.
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, AB, Canada T6G 1C9.
authors.forename: Seema
authors.initials: S
authors.lastname: Rajani
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, AB, Canada T6G 1C9.
authors.forename: Hien Q
authors.initials: HQ
authors.lastname: Huynh
authors.affiliation: Multidisciplinary Pediatric Celiac Clinic, Stollery Children's Hospital, Edmonton, AB, Canada T6G 2B7.
authors.forename: Leanne
authors.initials: L
authors.lastname: Shirton
authors.affiliation: Multidisciplinary Pediatric Celiac Clinic, Stollery Children's Hospital, Edmonton, AB, Canada T6G 2B7.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Kluthe
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, AB, Canada T6G 1C9.
authors.forename: Donald
authors.initials: D
authors.lastname: Spady
authors.affiliation: Department of Laboratory Medicine and Pathology, Department of Medicine, University of Alberta, AB, Canada T6G 2R3.
authors.forename: Connie
authors.initials: C
authors.lastname: Prosser
authors.affiliation: Cumming School of Medicine, University of Calgary, Calgary, AB, Canada T2N 4Z6.
authors.forename: Jon
authors.initials: J
authors.lastname: Meddings
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, AB, Canada T6G 1C9; Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada T9S 3A3.
authors.forename: Gwen R
authors.initials: GR
authors.lastname: Rempel
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, AB, Canada T6G 1C9.
authors.forename: Rabindranath
authors.initials: R
authors.lastname: Persad
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, AB, Canada T6G 1C9; Multidisciplinary Pediatric Celiac Clinic, Stollery Children's Hospital, Edmonton, AB, Canada T6G 2B7.
authors.forename: Justine M
authors.initials: JM
authors.lastname: Turner
mesh_terms: D000293:Adolescent; D000906:Antibodies / Q000097:blood; D001706:Biopsy; D002170:Canada; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis* / Q000178:diet therapy; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D016099:Endoscopy, Gastrointestinal / Q000379:methods / Q000706:statistics & numerical data*; D005243:Feces / Q000737:chemistry; D005260:Female; D006680:HLA Antigens / Q000097:blood; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000473:pathology; D007792:Lactulose / Q000493:pharmacokinetics; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D008297:Male; D008353:Mannitol / Q000493:pharmacokinetics; D010539:Permeability; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012698:Serologic Tests / Q000379:methods / Q000706:statistics & numerical data*; D013395:Sucrose / Q000493:pharmacokinetics; D013997:Time Factors; D011503:Transglutaminases / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D006680:HLA Antigens; D039841:Leukocyte L1 Antigen Complex; D008353:Mannitol; D007792:Lactulose; D013395:Sucrose; D011503:Transglutaminases