{
  "abstract": "Lucina has spent many an hour with a Crosby capsule, a radiology department and a gagging child waiting to trigger the capsule with an empty syringe, only to find a piece of carrot rather than a small bowel biopsy for histological confirmation of coeliac disease. It was such a relief when gastroenterologists then went on to use their gastroscopes for this investigation. Then, the highly sensitive serum markers with their assays were developed. In 2012, it was suggested by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition that a biopsy was not required to diagnose coeliac disease where children were symptomatic and they had a disease-permissive human leucocyte antigen (HLA) genotype (eg, DQ2/8), a raised antitissue transglutaminase immunoglobulin (tTG IgA) and a positive anti-endomysial antibody immunoglobulin A on a separate blood sample. Subsequently, the need for HLA typing was no longer required. This has always caused Lucina concern, as the diagnosis of coeliac disease infers lifelong dietary exclusion and control and potential long-term oncological issues. It was interesting to see the paper by Chang et al (Pediatrics. 2025;156(3):e2025070897), from North America, where they have not adopted these guidelines. In this multicentre retrospective cohort study of 4019 children (<18 years) who had an elevated tTG IgA within 6 months of an oesophagogastroduodenoscopy, histological findings were consistent with coeliac disease for 3321 children (PPV=82.6%, 95% CI 81.4 to 83.8). In those children, 1739/4019 (43.2%) children with the highest tTG IgA of greater than or equal to 10× ULN, 1651 had biopsy-confirmed coeliac disease (PPV10×=94.9%, 95% CI 93.8 to 95.9). 5% (88/1739) of children did not have histological findings of coeliac disease, including 41/1739 (2%) with normal histology. There was huge variability of the assays used across North America (there were six different assay tools available), and the assays performed worse in children with type 1 diabetes mellitus. So, these data confirm that a biopsy is still needed, as just using the serum markers will lead to overdiagnosis of coeliac disease and unnecessary lifelong interventions. Keep referring to the gastroenterologists for histological diagnosis, especially in those who are more at risk.",
  "authors": [
    {
      "affiliations": [],
      "name": "BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health"
    }
  ],
  "title": "Highlights from the literature",
  "uid": "9c5fb6fa-34a0-514f-bc1a-46dcfc75db26"
}