BMJ  2007;334:864 (28 April), doi:10.1136/bmj.39191.706505.3A

Letters

Coeliac disease

Decision tool needs to be developed for children

The decision tool for coeliac disease developed by Hopper et al is restricted to adults.¹ However, coeliac disease often presents in childhood when symptoms and signs can be different from those in adulthood.^{2 3} It may therefore be inappropriate to use the clinical characteristics suggested by Hopper et al when dividing children into high risk and low risk groups with respect to coeliac disease.

The second part of the clinical decision tool of Hopper et al is testing with tissue transglutaminase autoantibodies.¹ Also here clinicians need to consider the implications of age. In a recent review by Rostom et al,⁴ the pooled sensitivity of human tissue transglutaminase IgA autoantibodies was lower in children (95.7%) than in adults (98.1%); more false negative cases can therefore be expected.

We therefore suggest that the clinical decision tool proposed by Hopper et al should be adapted for children, and thereafter tested prospectively in an unselected population.

¹ Department of Paediatrics, Örebro University Hospital, 701 85 Örebro, Sweden, ² Department of Public Health and Clinical Medicine, Umeå University, Sweden

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Competing interests: None declared.

References

1. Hopper AD, Cross SS, Hurlstone DP, McAlindon ME, Lobo AJ, Hadjivassiliou M, et al. Pre-endoscopy serological testing for coeliac disease: evaluation of a clinical decision tool. BMJ 2007;334:729-32. (7 April.)[Abstract/Free Full Text]
2. Fasano A. Clinical presentation of celiac disease in the pediatric population. Gastroenterology 2005;128(4 suppl 1):S68-73.[CrossRef][ISI][Medline]
3. Ludvigsson JF, Ansved P, Falth-Magnusson K, Hammersjo JA, Johansson C, Edvardsson S, et al. Symptoms and signs have changed in Swedish children with coeliac disease . J Pediatr Gastroenterol Nutr 2004;38(2):181-6.[ISI][Medline]
4. Rostom A, Dube C, Cranney A, Saloojee N, Sy R, Garritty C, et al. The diagnostic accuracy of serologic tests for celiac disease: a systematic review. Gastroenterology 2005;128(4 suppl 1):S38-46.[CrossRef][ISI][Medline]

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Relevant Article

Pre-endoscopy serological testing for coeliac disease: evaluation of a clinical decision tool

Andrew D Hopper, Simon S Cross, David P Hurlstone, Mark E McAlindon, Alan J Lobo, Marios Hadjivassiliou, Marion E Sloan, Simon Dixon, and David S Sanders
BMJ 2007 334: 729. [Abstract] [Full Text] [PDF]