A Serological Diagnosis of Celiac Disease: A Pilot Study Toward Changing Local Practice

Abstract

Introduction: Celiac disease (CD) is the most common autoimmune disorder of the gastrointestinal tract. In 2012, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition changed their guidelines for CD diagnosis to include a serological diagnosis for certain patients instead of an endoscopy followed by biopsy. The purpose of this study is: (1) to apply a modified serological protocol in a prospective manner, (2) to evaluate the use of non-invasive monitoring of mucosal damage and (3) conduct qualitative interviews to determine if diagnostic strategy affects outcome, on a gluten free diet (GFD). Methods: Pediatric patients were given the option of a serological diagnosis if their anti-tissue transglutaminase (aTTG) level was ≥200 U/mL. Those that had an aTTG <200 U/mL were diagnosed by biopsy. In both groups, intestinal permeability and inflammation were assessed using standard non-invasive measurements of sugar probes in urine and fecal calprotectin. Parental phone interviews were also conducted in a subset of each diagnostic group. Conclusions: Our enrollment rate and parent response in interviews demonstrate that, in our local center, parents and patients welcome a non-invasive diagnostic strategy. There were no adverse affects in regards to symptom improvement or adherence to the GFD in those diagnosed by serology. After 12 months of treatment on a gluten-free diet, all CD patients showed recovery in intestinal permeability and inflammation through non-invasive measurements.