Awareness of ESPGHAN Guidelines on Coeliac Disease Amongst General Paediatricians in Southwest England

Background: ESPGHAN 2012 guidelines on coeliac disease (CD) recommend that symptomatic children with anti-tissue transglutaminase titres (anti-tTG) >10x upper limit of normal (ULN), positive anti-endomysial antibody (EMA) results, and if HLA-DQ2/8 positive, can be diagnosed without a biopsy. However, non-biopsy diagnosis is not appropriate for: asymptomatic high-risk children (e.g. diabetes, first-degree relatives, Down`s syndrome) and those with anti-tTG

Aims:

1) To gain an understanding of awareness and use of ESPGHAN guidelines for diagnosing CD in children amongst general paediatricians

2) Provide recommendations to increase awareness if required.

Methods: A telephone/email survey was conducted of general paediatric consultants (n≈140) across Southwest England with 12 DGHs. Survey included 8 questions to assess awareness and use of ESPGHAN guidelines, incorporating 3 main themes: when non-biopsy diagnoses can be made, when HLA-DQ2/8 genotyping should be requested and whether asymptomatic children from high-risk groups with anti-tTG>10xULN can be diagnosed without a biopsy.

Results: 101/140 (72%) responses obtained. 99% paediatricians were aware of ESPGHAN guidelines including non-biopsy/biopsy pathways for CD. 83% paediatricians were unable to state all criteria required for non-biopsy diagnosis. None could describe all appropriate situations where HLA-DQ2/8 genotyping should be requested. 33% paediatricians responded that asymptomatic children with anti-tTG>10xULN can be diagnosed with CD without a biopsy while 24% said they would seek advice.

Conclusions: Survey highlighted need for greater in-depth awareness of non-biopsy pathway and situations where HLA-DQ2/8 genotyping is indicated. There is possible misinterpretation regarding the ESPGHAN guidelines as 1/3^rd of paediatricians considered non-biopsy pathway is applicable for asymptomatic children with anti-tTG>10xULN. There is need for improved understanding of the ESPGHAN guidelines amongst general paediatricians. A user friendly Apps is planned to improve the diagnostic process.