Role of serological tests in the diagnosis of coeliac disease in children in New Zealand

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Abstract
Aim: To circumvent the need for an endoscopic biopsy to establish the diagnosis of coeliac disease (CD), the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) introduced a non‐biopsy pathway for selected children in 2012. This pathway was recently updated to utilise anti‐tissue transglutaminase IgA (anti‐TTG IgA), 10× upper limit of normal (ULN) and positive endomysial antibodies (EMA). This study focused on the retrospective application of these guidelines in children from two regions of New Zealand.Methods: Children aged <18 years who had anti‐TTG IgA measured and underwent oesophagogastroduodenoscopy over a 30‐month period were identified retrospectively. Medical records were reviewed to determine whether patients subsequently had biopsy‐proven CD (Marsh ≥2).Results: One hundred and thirty‐six children, with a mean age (±standard deviation) of 9.9 ± 4.2 years, fulfilled the study criteria and 101 (74%) of these children had positive anti‐TTG IgA. Eighty‐two of 136 (60%) children had biopsy‐proven CD. Positive anti‐TTG IgA and EMA were highly sensitive in diagnosing CD, 96.3 and 98.6%, respectively. Anti‐TTG‐IgA ≥10× ULN alone, and combined anti‐TTG IgA ≥10× ULN with positive EMA, both provided positive predictive values of 100% in diagnosing CD. Nineteen of 103 (18%) children could have been diagnosed with CD based on the ESPGHAN non‐biopsy criteria.Conclusion: A proportion of New Zealand children with CD can potentially be diagnosed using the latest ESPGHAN non‐biopsy criteria. However, prospective studies are required to validate this conclusion.
Funding Information
  • Freemasons New Zealand

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