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Barriers to implementing the revised ESPGHAN guidelines for coeliac disease in children: a cross-sectional survey of coeliac screen reporting in laboratories in England.
Arch Dis Child 2017; 102(10):942-946AD

Abstract

BACKGROUND

European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines for diagnosing paediatric coeliac disease (CD) were revised in 2012. This enabled serological diagnosis in a selective group of symptomatic children using anti-tissue transglutaminase (anti-tTG) titre, antiendomysial antibodies (EMA) and HLA DQ2/DQ8 status. However, observing variations in the availability of serological tests for CD within our region, we conducted a countrywide survey to explore the diversity of these tests for all paediatric centres.

METHODS

A nationwide telephone survey among biomedical scientists based in 139 National Health Service hospital trusts providing paediatric services in England was conducted by a single interviewer over a defined 3-week period. Respondents were asked about type of anti-tTG assay, the upper limit of normal (ULN) for anti-tTG titres, availability of EMA and reporting of IgA concentration.

RESULTS

Responses were available from 134 (96.4%) laboratories. Anti-tTG titres are performed by 83/134 (62.6%) laboratories and 68/83 (81.4%) of those also offered EMA testing. Four different anti-tTG assays are available in England, but there are 10 different ULN values. The range for ULN varies widely from 4 to 30 IU/mL. Automatic reporting of total IgA concentration for a coeliac serology request occurs in only 24/83 laboratories.

CONCLUSIONS

Significant heterogeneity exists for serological tests for CD in particular anti-tTG titre reporting even within the same regions. This potentially affects the interpretation of the results by clinicians diagnosing CD and hence harbouring diagnostic inconsistencies in their practice. Standardisation especially of the anti-tTG assays and routine reporting of IgA concentration nationally should be strongly considered to support the current diagnostic process for CD.

Authors+Show Affiliations

Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK.Medical School, University of Bristol, Bristol, UK.Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK. Medical School, University of Bristol, Bristol, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28483757

Citation

Paul, Siba Prosad, et al. "Barriers to Implementing the Revised ESPGHAN Guidelines for Coeliac Disease in Children: a Cross-sectional Survey of Coeliac Screen Reporting in Laboratories in England." Archives of Disease in Childhood, vol. 102, no. 10, 2017, pp. 942-946.
Paul SP, Harries SL, Basude D. Barriers to implementing the revised ESPGHAN guidelines for coeliac disease in children: a cross-sectional survey of coeliac screen reporting in laboratories in England. Arch Dis Child. 2017;102(10):942-946.
Paul, S. P., Harries, S. L., & Basude, D. (2017). Barriers to implementing the revised ESPGHAN guidelines for coeliac disease in children: a cross-sectional survey of coeliac screen reporting in laboratories in England. Archives of Disease in Childhood, 102(10), pp. 942-946. doi:10.1136/archdischild-2016-312027.
Paul SP, Harries SL, Basude D. Barriers to Implementing the Revised ESPGHAN Guidelines for Coeliac Disease in Children: a Cross-sectional Survey of Coeliac Screen Reporting in Laboratories in England. Arch Dis Child. 2017;102(10):942-946. PubMed PMID: 28483757.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Barriers to implementing the revised ESPGHAN guidelines for coeliac disease in children: a cross-sectional survey of coeliac screen reporting in laboratories in England. AU - Paul,Siba Prosad, AU - Harries,Sophie Louise, AU - Basude,Dharamveer, Y1 - 2017/05/08/ PY - 2016/09/20/received PY - 2017/03/27/revised PY - 2017/03/30/accepted PY - 2017/5/10/pubmed PY - 2017/10/7/medline PY - 2017/5/10/entrez KW - Anti-tissue transglutaminase KW - Coeliac disease KW - ESPGHAN guidelines KW - Gastroenterology KW - General Paediatrics KW - Laboratory medicine SP - 942 EP - 946 JF - Archives of disease in childhood JO - Arch. Dis. Child. VL - 102 IS - 10 N2 - BACKGROUND: European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines for diagnosing paediatric coeliac disease (CD) were revised in 2012. This enabled serological diagnosis in a selective group of symptomatic children using anti-tissue transglutaminase (anti-tTG) titre, antiendomysial antibodies (EMA) and HLA DQ2/DQ8 status. However, observing variations in the availability of serological tests for CD within our region, we conducted a countrywide survey to explore the diversity of these tests for all paediatric centres. METHODS: A nationwide telephone survey among biomedical scientists based in 139 National Health Service hospital trusts providing paediatric services in England was conducted by a single interviewer over a defined 3-week period. Respondents were asked about type of anti-tTG assay, the upper limit of normal (ULN) for anti-tTG titres, availability of EMA and reporting of IgA concentration. RESULTS: Responses were available from 134 (96.4%) laboratories. Anti-tTG titres are performed by 83/134 (62.6%) laboratories and 68/83 (81.4%) of those also offered EMA testing. Four different anti-tTG assays are available in England, but there are 10 different ULN values. The range for ULN varies widely from 4 to 30 IU/mL. Automatic reporting of total IgA concentration for a coeliac serology request occurs in only 24/83 laboratories. CONCLUSIONS: Significant heterogeneity exists for serological tests for CD in particular anti-tTG titre reporting even within the same regions. This potentially affects the interpretation of the results by clinicians diagnosing CD and hence harbouring diagnostic inconsistencies in their practice. Standardisation especially of the anti-tTG assays and routine reporting of IgA concentration nationally should be strongly considered to support the current diagnostic process for CD. SN - 1468-2044 UR - https://www.unboundmedicine.com/medline/citation/28483757/Barriers_to_implementing_the_revised_ESPGHAN_guidelines_for_coeliac_disease_in_children:_a_cross_sectional_survey_of_coeliac_screen_reporting_in_laboratories_in_England_ L2 - http://adc.bmj.com/cgi/pmidlookup?view=long&pmid=28483757 DB - PRIME DP - Unbound Medicine ER -