Diagnosis in children

NICE recommends that children with positive serological test results are referred to a paediatric gastroenterologist or paediatrician with a specialist interest in gastroenterology for further investigation for coeliac disease.

In recent years diagnosis was based on serological testing for antibodies followed by a biopsy. However, the accuracy of blood tests has improved and the need for biopsy may lead to delayed diagnosis and treatment.

The BSPGHAN guideline recommends that children with symptoms and whose blood tests show a high level of IgA tissue transglutaminase antibodies (x10 x upper limit of normal for assay) and who are HLA-DQ2/ DQ8 positive may not need to undergo biopsy to secure diagnosis.

The new recommended approach will aid more accurate diagnosis, help children get treated more quickly and should bring savings to the NHS.