title: Diagnosis of celiac disease and applicability of ESPGHAN guidelines in Mediterranean countries: a real life prospective study.
abstract: BACKGROUND
  We assessed how the diagnosis of Celiac Disease (CD) is made and how the new ESPGHAN guidelines can be applied in children from countries with different resources.
  
  
  METHODS
  A real life prospective study was performed in 14 centres of 13 different Mediterranean countries. Participants were asked to apply the usual diagnostic work-up for CD according to their diagnostic facilities.
  
  
  RESULTS
  There were 1974 patients enrolled in the study, mean age 4 years, 10 months; 865 male, 1109 female. CD was confirmed in 511 (25.9%) and was unconfirmed in 1391 (70.5%) patients; 14 patients were diagnosed as having CD according to the new ESPGHAN guidelines, 43 patients were classified as having potential CD. In all participating countries the diagnosis of CD relied on histology of duodenal biopsy; in 5 countries, HLA, and in one country endomysial antibodies (EMA) were not available. Symptoms did not add a significant increase to the pre-test probability of serological tests. The positive predictive value of tissue transglutaminase type 2 (tTG) antibodies performed with different kits but all corresponding to those recommended by ESPGHAN was 96.1% (95% CI 94-97.9%) in presence of tTG > 10xULN. In 135 patients with tTG >10xULN, HLA genotyping was performed and in all it was compatible with CD.
  
  
  CONCLUSIONS
  The results of our study show that CD diagnosis still relies on intestinal biopsy in the Mediterranean area. New ESPGHAN criteria are not applicable in 5 countries due to lack of resources needed to perform HLA genotyping and, in one country, EMA assay. Further simplification of the new ESPGHAN guidelines might be made according to what preliminarily the present results suggest if confirmed by new prospective studies.
authors.affiliation: Department of Translational Medical Sciences, School of Medicine, University "Federico II", Naples, Italy.|European Laboratory for Food Induced Diseases, Naples, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Smarrazzo
authors.affiliation: Children's Hospital Zagreb, Zagreb, Croatia.
authors.forename: Zrinjka
authors.initials: Z
authors.lastname: Misak
authors.affiliation: Celiac Regional Centre, Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Costa
authors.affiliation: Paediatric Department, University Medical Centre, Maribor, Slovenia.
authors.forename: Dušanka
authors.initials: D
authors.lastname: Mičetić-Turk
authors.affiliation: Cairo University Children Hospital, El Cairo, Egypt.
authors.forename: Mona
authors.initials: M
authors.lastname: Abu-Zekry
authors.affiliation: Department of Pediatric Gastroenterology, School of Medicine, Ankara University, Ankara, Turkey.
authors.forename: Aydan
authors.initials: A
authors.lastname: Kansu
authors.affiliation: Centre Hospitalier Universitaire Ibnou Rochd, Casablanca, Morocco.
authors.forename: Abdelhak
authors.initials: A
authors.lastname: Abkari
authors.affiliation: Faculté de Médecine d'Oran, Oran, Algeria.
authors.forename: Karim
authors.initials: K
authors.lastname: Bouziane-Nedjadi
authors.affiliation: Pediatric Unit, Mongi SLIM's Hospital of Tunis, Marsa, Tunisia.
authors.forename: Mongi
authors.initials: M
authors.lastname: Ben Hariz
authors.affiliation: First Department of Pediatrics, University of Athens, Athens, Greece.
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Roma
authors.affiliation: Service of Pediatric Gastroenterology "Mother Teresa" Hospital, Tirana, Albania.
authors.forename: Virtut
authors.initials: V
authors.lastname: Velmishi
authors.affiliation: Paediatric Gastroenterology Unit, Cruces University Hospital, Bilbao, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Legarda Tamara
authors.affiliation: University of Malta, Msida, Malta.
authors.forename: Thomas
authors.initials: T
authors.lastname: Attard
authors.affiliation: Clinical Center of Montenegro, Podgorica, Montenegro.
authors.forename: Veselinka
authors.initials: V
authors.lastname: Djurisic
authors.affiliation: Department of Translational Medical Sciences, School of Medicine, University "Federico II", Naples, Italy.|European Laboratory for Food Induced Diseases, Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Greco
authors.affiliation: Celiac Regional Centre, Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy. magazzug@unime.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Magazzù
mesh_terms: D001323:Autoantibodies / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis*; D002675:Child, Preschool; D003238:Connective Tissue / Q000276:immunology; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology; D060005:Genotyping Techniques; D019983:Guideline Adherence; D006680:HLA Antigens / Q000235:genetics; D006295:Health Resources; D006801:Humans; D007422:Intestines / Q000473:pathology; D008297:Male; D019083:Mediterranean Region; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases / Q000276:immunology
chemical_list: D001323:Autoantibodies; D006680:HLA Antigens; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins
keywords: Celiac disease; Diagnosis; ESPGHAN; Mediterranean area