PMID- 33908736
OWN - NLM
STAT- MEDLINE
DCOM- 20210709
LR  - 20230822
IS  - 1536-4801 (Electronic)
IS  - 0277-2116 (Linking)
VI  - 72
IP  - 6
DP  - 2021 Jun 1
TI  - Celiac Disease Management in the United Kingdom Specialist Pediatric 
      Gastroenterology Centers-A Service Survey.
PG  - e149-e153
LID - 10.1097/MPG.0000000000003126 [doi]
AB  - OBJECTIVES: The 2012 European Society for Paediatric Gastroenterology, Hepatology 
      and Nutrition (ESPGHAN) guidelines on celiac disease (CD) recommended a no-biopsy 
      pathway (NBP) for symptomatic children with high immunoglobin A (IgA)-based 
      anti-tissue transglutaminase (TGA-IgA) titers, positive anti-endomysial antibody 
      and human leukocyte antigen (HLA)-DQ2/DQ8 status. We aimed to understand 
      variations in practice amongst specialist pediatric gastroenterology centers 
      (SPGIC) in the United Kingdom (UK). METHODS: A survey questionnaire was sent to 
      all UK SPGIC (n = 29) providing endoscopy services for CD diagnosis. It was 
      divided into four main subgroups: analyzing diagnosis of CD through adherence to 
      the ESPGHAN (2012) guidelines, post-diagnosis care and long-term follow-up and 
      discharge from pediatric services. RESULTS: All 29 responded. NBP was implemented 
      in 28 of 29 centers. Five of 29 centers had already stopped HLA-DQ2/DQ8 testing 
      for NBP diagnosis. Twenty six of 29 centers were performing endoscopy on 
      screening-identified children (mostly asymptomatic, "at-risk" patients). 
      Diagnosis was communicated by a doctor in 65% SPGIC (n = 19). Most centers 
      (n = 23) waited 6-12 months post-diagnosis to start gluten-free oats. Routine 
      vitamin D supplementation was commenced by 4 of 29 centers. All centers repeated 
      TGA-IgA to assess normalization but at varying times post-GFD. Follow-up was with 
      a combination of doctors/dieticians (n = 26). Eleven of 29 centers discharged 
      their patient to primary care. CONCLUSIONS: There was excellent uptake of ESPGHAN 
      guidelines (2012) in the UK and adherence to guidelines is generally good. 
      Despite published evidence and pragmatic advice from the British Society of 
      Paediatric Gastroenterology Hepatology and Nutrition and National Institute for 
      Health and Care Excellence, significant differences remain in diagnostic and 
      ongoing management practice and are opportunities for research and directive 
      evidence-based follow-up guidance.
CI  - Copyright (c) 2021 by European Society for Pediatric Gastroenterology, Hepatology, 
      and Nutrition and North American Society for Pediatric Gastroenterology, 
      Hepatology, and Nutrition.
FAU - Paul, Siba Prosad
AU  - Paul SP
AD  - Department of Pediatrics, Yeovil District Hospital, Yeovil, United Kingdom.
FAU - Balakumar, Varathagini
AU  - Balakumar V
AD  - Medical School, Cardiff University, Cardiff, Wales.
FAU - Gillett, Peter Michael
AU  - Gillett PM
AD  - Department of Pediatric Gastroenterology, Royal Hospital for Sick Children, 
      Edinburgh, Scotland.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Pediatr Gastroenterol Nutr
JT  - Journal of pediatric gastroenterology and nutrition
JID - 8211545
RN  - EC 2.3.2.13 (Transglutaminases)
SB  - IM
MH  - *Celiac Disease/diagnosis/therapy
MH  - Child
MH  - Disease Management
MH  - *Gastroenterology
MH  - Humans
MH  - Surveys and Questionnaires
MH  - Transglutaminases
MH  - United Kingdom
COIS- The authors report no conflicts of interest.
EDAT- 2021/04/29 06:00
MHDA- 2021/07/10 06:00
CRDT- 2021/04/28 10:24
PHST- 2021/04/29 06:00 [pubmed]
PHST- 2021/07/10 06:00 [medline]
PHST- 2021/04/28 10:24 [entrez]
AID - 00005176-202106000-00020 [pii]
AID - 10.1097/MPG.0000000000003126 [doi]
PST - ppublish
SO  - J Pediatr Gastroenterol Nutr. 2021 Jun 1;72(6):e149-e153. doi: 
      10.1097/MPG.0000000000003126.