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2013 BSPGHAN guideline
This guideline extends the earlier BSPGHAN guideline (based on NASPGHAN Coeliac Guideline of 2005 1 and the original guideline from the Welsh Paediatric Gastroenterology MCN 2 ) to incorporate the changed ESPGHAN 2012 diagnostic guideline. 3 An outline of these guidelines ( figures 1 and 2 ) are also available to download from the BSPGHAN and Coeliac UK websites. The British Society of Gastroenterology (BSG) Coeliac Guideline for Adult Coeliac Disease, which differs in respect of biopsy stratagem, is available on the BSG website http://www.bsg.org.uk.
Coeliac disease (CD) is not simply a gastrointestinal condition but an immune-mediated systemic disorder, strongly dependent on the human leukocyte antigen (HLA)-DQ2 and DQ8 haplotypes. It is elicited by gluten and related prolamines in genetically susceptible individuals and characterised by a variable combination of gluten-dependent clinical manifestations, CD-specific antibodies and enteropathy. 3-7 Screening studies have shown prevalence much higher than previously recognised, and there is evidence of an increased incidence of both classic and non-classic presentations in UK children. 8
BSPGHAN recommends that all patients with suspected CD should have their diagnosis established by a paediatric gastroenterologist and their follow-up under the care of a paediatric gastroenterologist or a paediatrician with a special interest in CD, with access to appropriately skilled paediatric dietetic services. 9
Who to test
Box 1 Symptomatic children (gastrointestinal tract and non-gastrointestinal tract symptoms)
Persistent diarrhoea
Faltering growth, idiopathic short stature
Abdominal pain, vomiting, abdominal distension
Constipation
Dermatitis herpetiformis
Dental enamel defects
Osteoporosis/pathological fractures
Delayed menarche
Unexplained anaemia or iron deficient anaemia unresponsive to treatment
Recurrent aphthous stomatitis
Unexplained liver disease
Lassitude/weakness
Box 2 Asymptomatic but with associated condition (estimated lifetime prevalence)
Type I diabetes (>= 8%)
Selective IgA deficiency (1.7%-7.7%)
Down (5%-12%), Williams (8.2%) and Turner (4.1%-8.1%) Syndromes
Autoimmune thyroiditis (~15%)
Autoimmune liver disease
Unexplained raised transaminases without known liver disease
Intussusception
Dermatitis herpetiformis
Relatives of coeliac patient: First-degree relative (~10%)
HLA-matched sibling (~30%-40%)
Monozygotic twin (~70%)
CD should also be considered in juvenile idiopathic arthritis, epilepsy with associated intracranial calcification and unexplained neurological problems (palsies, neuropathies, migraine).
If screening parents or patients, families should be advised pretesting about relative risks of untreated CD and the need for biopsy and gluten-free diet (GFD) should the blood tests come back positive.
Ensure adequate...