Diagnosis of coeliac disease in children in primary care and clinical implications

摘要

Since the introduction of the Crosby capsule (a device used for obtaining biopsies of small bowel mucosa, necessary for the diagnosis of various small bowel diseases) in the 1970s, small intestinal biopsy has been the cornerstone of diagnosis of coeliac disease. In paediatric practice, successive position statements from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) have defined criteria for childhood diagnosis: initially based on three successive biopsies at presentation, on a gluten-free diet, and then challenge. Since 1990, the diagnosis has been dependent on a single biopsy with a clear clinical response to a gluten-free diet, supported by positive serology.1 This approach is similar to that recommended for adults2 and has been adopted by the National Institute for Health and Care Excellence (NICE).3