Coeliac disease in childrenBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k3932 (Published 09 October 2018) Cite this as: BMJ 2018;363:k3932
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We welcome the paper by Thomas et al (1) in respect of Coeliac disease in children and hope it may highlight this relatively common disease to the non-specialist in both primary and secondary care. It builds on other recent work and the BSPGHAN Coeliac UK guidelines (2) which are accessible to parents, young people and health professionals over the internet. We emphasize two additional areas that deserve attention and are not covered in the literature:
1. There is no persuasive evidence to support HLA typing in the diagnosis of coeliac disease neither using serology alone, nor when a duodenal biopsy is required. This is a costly and redundant investigation in most cases, which might be better used to exclude coeliac disease if negative, and avoid ongoing routine screening tests. For example, where the patient is a family member of an index case or belongs to a high risk group.
2. When investigating with IgA levels and IgA TTG serology the professional must advise the family and patient against a gluten free diet until testing is complete. Confirming this diagnosis requires an expert, and for children this will either be a Paediatric Gastroenterologist or a Consultant Paediatrician with specific additional training and experience. Unfortunately, too often, we observe that colleagues in both primary and secondary care are mistakenly diagnosing coeliac disease based on slightly abnormal serology without adhering to the agreed national guidance (2). This creates a dilemma and is confusing for the family, resulting in delayed diagnosis and prolongation of symptoms.
1. Thomas PC, Tighe MP & Beattie RM. Coeliac Disease in Children. BMJ 2018 363:120-122.
2. Murch S, Jenkins H, Auth M et al. Joint BSPGHAN and Coeliac UK guidelines for the diagnosis and management of coeliac disease in children. Arch Dis Child 2013 98:806-811.
Competing interests: No competing interests