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1.

001-es BibID:BIBFORM096521
035-os BibID:(WoS)000651551200033 (Scopus)85106198556
Első szerző:Görög A.
Cím:S2k guidelines (consensus statement) for diagnosis and therapy of dermatitis herpetiformis initiated by the European Academy of Dermatology and Venereology (EADV) / A. Görög, E. Antiga, M. Caproni, G. Cianchini, D. De, M. Dmochowski, J. Dolinsek, K. Drenovska, C. Feliciani, K. Hervonen, I. Lakos Jukic, Á. Kinyó, T. Koltai, I. Korponay-Szabó, A. V. Marzano, A. Patsatsi, C. Rose, T. Salmi, E. Schmidt, J. Setterfield, M. Shahid, C. Sitaru, S. Uzun, F. Valitutti, S. Vassileva, S. Yayli, M. Sárdy
Dátum:2021
ISSN:0926-9959
Megjegyzések:Introduction: Dermatitis herpetiformis (DH) is a chronic, pruritic, gluten-induced skin disorder characterized by subepidermal granular IgA deposition and a variable degree of enteropathy identical to that seen in coeliac disease. So far, there has been no European consensus about the management of DH. Methods: The guidelines were created by small subgroups of a guideline committee consisting of 26 specialists from various medical fields and one patients' representative. The members of the committee then discussed the guidelines and voted for the final version at two consensus meetings. The guidelines were developed under the support of the European Academy of Dermatology and Venereology (EADV) and in collaboration with the European Dermatology Forum (EDF). Results: The guidelines summarize evidence-based and expert-based recommendations (S2 level) for the management of DH (see Appendix). Conclusion: These guidelines will improve the quality of management of DH and support dermatologists in their diagnostic and therapeutic decisions.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
dermatitis herpetiformis
coeliac disease
Megjelenés:Journal of The European Academy of Dermatology And Venereology. - 35 : 6 (2021), p. 1251-1277. -
További szerzők:Antiga, E. Caproni, M. Cianchini, G. De, D. Dmochowski, M. Dolinśek, Jernej Drenovska, K. Feliciani, C. Hervonen, K. Lakos Jukic I. Kinyó Ágnes Koltai Tünde Korponay-Szabó Ilma (1959-) (gyermekgyógyász) Marzano, Angelo V. Patsatsi, A. Rose, C. Salmi, T. T. Schmidt E. Setterfield, J. Shahid, M. Sitaru, C. Uzun, S. Valitutti, Francesco Vassileva, S. Yayli, S. Sárdy Miklós
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2.

001-es BibID:BIBFORM091976
Első szerző:Husby, Steffen
Cím:European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020 / Steffen Husby, Sibylle Koletzko, Ilma Korponay-Szabó, Kalle Kurppa, Maria Luisa Mearin, Carmen Ribes-Koninckx, Raanan Shamir, Riccardo Troncone, Renata Auricchio, Gemma Castillejo, Robin Christensen, Jernej Dolinsek, Peter Gillett, Asbjørn Hróbjartsson, Tunde Koltai, Markku Maki, Sabrina Mai Nielsen, Alina Popp, Ketil Størdal, Katharina Werkstetter, Margreet Wessels
Dátum:2020
ISSN:0277-2116
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Journal of pediatric gastroenterology and nutrition. - 70 : 1 (2020), p. 141-156. -
További szerzők:Koletzko, Sibylle Korponay-Szabó Ilma (1959-) (gyermekgyógyász) Kurppa, Kalle Mearin, Maria Luisa Ribes-Koninckx, Carmen Shamir, Raanan (gyermekgyógyász) Troncone, Riccardo Auricchio, Renata Castillejo, Gemma (gyermekgyógyász, gasztroenterológus) Christensen, Robin Dolinśek, Jernej Gillett, Peter Hróbjartsson, Asbjørn Koltai Tünde Mäki, Markku Nielsen, Sabrina Mai Popp, Alina Størdal, Ketil Werkstetter, Katharina (gyermekgyógyász, gasztroenterológus) Wessels, Margreet
Internet cím:Intézményi repozitóriumban (DEA) tárolt változat
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3.

001-es BibID:BIBFORM103510
035-os BibID:(Wos)000841921200031 (Scopus)85136851907
Első szerző:Mearin, Maria Luisa
Cím:ESPGHAN Position Paper on Management and Follow-up of Children and Adolescents With Celiac Disease / Mearin Maria Luisa, Agardh Daniel, Antunes Henedina, Al-toma Abdul, Auricchio Renata, Castillejo Gemma, Catassi Carlo, Ciacci Carolina, Discepolo Valentina, Dolinsek Jernej, Donat Ester, Gillett Peter, Guandalini Steffano, Husby Steffen, Koletzko Sibylle, Koltai Tunde, Korponay-Szabó Ilma Rita, Kurppa Kalle, Lionetti Elena, Marild Karl, Martinez Ojinaga Eva, Meijer Caroline, Monachesi Chiara, Polanco Isabel, Popp Alina, Roca Maria, Rodriguez-Herrera Alfonso, Shamir Raanan, Størdal Ketil, Troncone Riccardo, Valitutti Francesco, Vreugdenhil Anita, Wessels Margreet, Whiting Penny, ESPGHAN Special Interest Group on Celiac Disease
Dátum:2022
ISSN:0277-2116
Megjegyzések:Objectives: To gather the current evidence and to offer recommendations for follow-up and management. Methods: The Special Interest Group on Celiac Diseases of the European Society of Paediatric Gastroenterology Hepatology and Nutrition formulated ten questions considered to be essential for follow-up care. A literature search (January 2010-March 2020) was performed in PubMed or Medline. Relevant publications were identified and potentially eligible studies were assessed. Statements and recommendations were developed and discussed by all coauthors. Recommendations were voted upon: joint agreement was set as at least 85%. Results: Publications (n = 2775) were identified and 164 were included. Using evidence or expert opinion, 37 recommendations were formulated on: The need to perform follow-up, its frequency and what should be assessed, how to assess adherence to the gluten-free diet, when to expect catch-up growth, how to treat anemia, how to approach persistent high serum levels of antibodies against tissue-transglutaminase, the indication to perform biopsies, assessment of quality of life, management of children with unclear diagnosis for which a gluten-challenge is indicated, children with associated type 1 diabetes or IgA deficiency, cases of potential celiac disease, which professionals should perform follow-up, how to improve the communication to patients and their parents/caregivers and transition from pediatric to adult health care. Conclusions: We offer recommendations to improve follow-up of children and adolescents with celiac disease and highlight gaps that should be investigated to further improve management.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Journal Of Pediatric Gastroenterology And Nutrition. - 75 : 3 (2022), p. 369-386. -
További szerzők:Agardh, Daniel Antunes, Henedina Al-toma, Abdul Auricchio, Renata Castillejo, Gemma (gyermekgyógyász, gasztroenterológus) Catassi, Carlo Ciacci, Carolina Discepolo, Valentina Dolinśek, Jernej Donat, Ester Gillett, Peter Guandalini, Steffano Husby, Steffen Koletzko, Sibylle Koltai Tünde Korponay-Szabó Ilma (1959-) (gyermekgyógyász) Kurppa, Kalle Lionetti, Elena Marild, Karl Martinez Ojinaga, Eva Meijer, Caroline R. Monachesi, Chiara Polanco, Isabel Popp, Alina Roca, María Rodriguez-Herrera, Alfonso Shamir, Raanan (gyermekgyógyász) Størdal, Ketil Troncone, Riccardo Valitutti, Francesco Vreugdenhil, Anita C. E. Wessels, Margreet Whiting, Penny ESPGHAN Special Interest Group on Celiac Disease
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4.

001-es BibID:BIBFORM096507
035-os BibID:(cikkazonosító)9370397
Első szerző:Riznik, Petra
Cím:The Use of Biopsy and "No-Biopsy" Approach for Diagnosing Paediatric Coeliac Disease in the Central European Region / Riznik Petra, Balogh Márta, Bódi Piroska, De Leo Luigina, Dolinsek Jasmina, Guthy Ildikó, Gyimesi Judit, Horváth Ágnes, Kis Ildikó, Klemenak Martina, Koletzko Berthold, Koletzko Sibylle, Korponay-Szabó Ilma Rita, Krencnik Tomaz, Not Tarcisio, Palcevski Goran, Pollák Éva, Sblattero Daniele, Tokodi István, Vogrincic Matej, Werkstetter Katharina Julia, Dolinsek Jernej
Dátum:2019
ISSN:1687-6121 1687-630X
Megjegyzések:Objectives: The current European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines introduced the option to diagnose coeliac disease (CD) in children and adolescents without upper endoscopy if the defined criteria are met. The aim of our study was to evaluate how frequently paediatric gastroenterologists in Central Europe used the "no-biopsy" approach and how often the duodenal biopsy could have been omitted. Methods: Medical records of patients aged < 19 years diagnosed with CD in 2016 from five European countries were analysed, focusing on levels of transglutaminase antibodies (TGA) at the time of diagnosis and on whether the diagnosis was confirmed using duodenal biopsy or "no-biopsy" approach. Clinical presentation and delays until final diagnosis were analysed according to diagnostic approach. Results: Data from 653 children (63.9% female, median age: 7 years, range: 7 months-18.5 years) from Croatia, Hungary, Germany, Italy, and Slovenia were analysed. One fifth (n = 134) of included children were asymptomatic at diagnosis. Of 519 symptomatic children, 107 (20.6%) were diagnosed by the "no-biopsy" approach. Out of the remaining 412 children who underwent duodenal biopsies, 214 (51.9%) had TGA ? 10 times upper level of normal (ULN) and would have been eligible for the "no-biopsy" approach. Signs and symptoms of malabsorption were more frequent in children diagnosed without duodenal biopsies. There were no differences in diagnostic delays with respect to the diagnostic approach. Conclusion: In this cohort, about 60% of symptomatic CD patients could have been diagnosed without duodenal biopsies. The aim of the "no-biopsy" approach was to make the diagnostic procedure less challenging without compromising its reliability. However, this option was applied only in 20%, in spite of fewer burdens to the family and reduced costs. The reasons for this discrepancy are unknown. Physicians should be made more aware about the reliability of CD diagnosis without biopsies when the ESPGHAN guidelines for CD diagnosis are followed
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
coeliac disease
Megjelenés:Gastroenterology Research And Practice. - 2019 (2019), p. 1-6. -
További szerzők:Balogh Márta Bodi Piroska De Leo, Luigina Dolinsek, Jasmina Guthy Ildikó Gyimesi Judit Horváth Ágnes (Veszprém) Kis Ildikó Klemenak, Martina Koletzko, Berthold Koletzko, Sibylle Korponay-Szabó Ilma (1959-) (gyermekgyógyász) Krencnik, Tomaz Not, Tarcisio Palcevski, Goran Pollák Éva Sblattero, Daniele Tokodi István Vogrincic, Matej Werkstetter, Katharina (gyermekgyógyász, gasztroenterológus) Dolinśek, Jernej
Pályázati támogatás:NKFIH 120392
NKFIH
EFOP-3.6.1-16-2016-00022
EFOP
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5.

001-es BibID:BIBFORM096516
Első szerző:Riznik, Petra
Cím:Management of coeliac disease patients after the confirmation of diagnosis in Central Europe / Riznik Petra, De Leo Luigina, Dolinsek Jasmina, Gyimesi Judit, Klemenak Martina, Koletzko Berthold, Koletzko Sibylle, Koltai Tunde, Korponay-Szabó Ilma Rita, Krencnik Tomaz, Milinovic Marina, Not Tarcisio, Palcevski Goran, Sblattero Daniele, Werkstetter Katharina Julia, Dolinsek Jernej
Dátum:2022
ISSN:0954-691X
Megjegyzések:Background: Recently published paediatric guidelines for diagnosing coeliac disease do not include recommendations on the follow-up of coeliac disease patients. Goal: The aim of this study was to assess the management practices and experience of coeliac disease patients with their follow-up appointments in Central Europe. Study: Gastroenterologists and coeliac disease patients in five Central European countries were asked to complete the web-based questionnaire focusing on coeliac disease management practices. Results: Answers from 147 gastroenterologists and 2041 coeliac disease patients were available for the analysis. More than half of the gastroenterologists (58.5%) schedule the first follow-up visit within 3 months after the diagnosis. At follow-up, tissue transglutaminase antibodies are checked in almost all patients (95.9%). Approximately two-thirds (60.7%) of gastroenterologists refer all of their patients to the dietitian at diagnosis. Similarly, 42.8% of coeliac disease patients reported that they had not been appointed to a dietitian. Almost one-third of coeliac disease patients (30.8%) reported that they had no follow-up appointments with gastroenterologist at all. Conclusions: Follow-up of coeliac disease patients is suboptimal in Central Europe. Many patients are not followed regularly. A lot of patients are not referred to a dietitian. The recommendations on the optimal follow-up of coeliac disease patients are needed in order to improve patient care
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
coeliac disease
adults
children
Central Europe
management
celiac disease
Megjelenés:European Journal Of Gastroenterology & Hepatology. - 34 : 1 (2022), p. 27-32. -
További szerzők:De Leo, Luigina Dolinsek, Jasmina Gyimesi Judit Klemenak, Martina Koletzko, Berthold Koletzko, Sibylle Koltai Tünde Korponay-Szabó Ilma (1959-) (gyermekgyógyász) Krencnik, Tomaz Milinovic, Marina Not, Tarcisio Palcevski, Goran Sblattero, Daniele Werkstetter, Katharina (gyermekgyógyász, gasztroenterológus) Dolinśek, Jernej
Pályázati támogatás:Interreg Central Europe CE111
Egyéb
EFOP-3.6.1-16-2016-00022
EFOP
NKFI120392
NKFIH
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6.

001-es BibID:BIBFORM096518
Első szerző:Riznik, Petra
Cím:Clinical Presentation in Children With Coeliac Disease in Central Europe / Riznik Petra, De Leo Luigina, Dolinsek Jasmina, Gyimesi Judit, Klemenak Martina, Koletzko Berthold, Koletzko Sibylle, Korponay-Szabó Ilma Rita, Krencnik Tomaz, Not Tarcisio, Palcevski Goran, Sblattero Daniele, Werkstetter Katharina Julia, Dolinsek Jernej
Dátum:2021
ISSN:0277-2116
Megjegyzések:Objectives: During the past decades, there has been a shift in the clinical presentation of coeliac disease (CD) to nonclassical, oligosymptomatic, and asymptomatic forms. We assessed clinical presentation of CD in children and adolescents in Central Europe. Methods: Paediatric gastroenterologists in 5 countries retrospectively reported data of their patients diagnosed with CD. Clinical presentation was analyzed and the differences among very young (<3 years) and older children and adolescents were studied. Results: Data from 653 children and adolescents (median age 7 years 2 months; 63.9% girls) from Croatia, Germany, Hungary, Italy, and Slovenia were available for the analysis. One fifth (N = 134) of all children were asymptomatic. In symptomatic children, the most common leading symptom was abdominal pain (33.3%), followed by growth retardation (13.7%) and diarrhoea (13.3%). The majority of symptomatic children (47.6%; N = 247) were polysymptomatic. Abdominal pain was the most common symptom in polysymptomatic (66.4%) as well as in monosymptomatic children (29.7%). Comparing clinical presentation of CD in very young children (younger than 3 years) with older children (3 years or older), we found that symptoms and signs of malabsorption were significantly more common in younger (P < 0.001), whereas abdominal pain and asymptomatic presentation were more common in older children and adolescents (both P < 0.001). Conclusion: In children with CD, abdominal pain has become the most common symptom. However, in younger children, symptoms of malabsorption are still seen frequently. This raises a question about the underlying mechanism of observed change in clinical presentation in favour of nonclassical presentation and asymptomatic disease at certain age.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
coeliac disease
Megjelenés:Journal Of Pediatric Gastroenterology And Nutrition. - 72 : 4 (2021), p. 546-551. -
További szerzők:De Leo, Luigina Dolinsek, Jasmina Gyimesi Judit Klemenak, Martina Koletzko, Berthold Koletzko, Sibylle Korponay-Szabó Ilma (1959-) (gyermekgyógyász) Krencnik, Tomaz Not, Tarcisio Palcevski, Goran Sblattero, Daniele Werkstetter, Katharina (gyermekgyógyász, gasztroenterológus) Dolinśek, Jernej
Pályázati támogatás:Interreg Central Europe CE111
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7.

001-es BibID:BIBFORM096517
Első szerző:Riznik, Petra
Cím:The Knowledge About Celiac Disease Among Healthcare Professionals and Patients in Central Europe / Riznik Petra, De Leo Luigina, Dolinsek Jasmina, Gyimesi Judit, Klemenak Martina, Koletzko Berthold, Koletzko Sibylle, Koltai Tunde, Korponay-Szabó Ilma Rita, Krencnik Tomaz, Milinovic Marina, Not Tarcisio, Palcevski Goran, Sblattero Daniele, Werkstetter Katharina Julia, Dolinsek Jernej
Dátum:2021
ISSN:0277-2116
Megjegyzések:Objectives: Celiac disease (CD) remains undiagnosed for a long time in many adult and pediatric patients. We assessed the knowledge about CD among healthcare professionals (HCPs) and CD patients in Central Europe (CE). Methods: HCPs and CD patients from 5 CE countries were asked to complete the web-based questionnaire about CD. The questions were divided into subsections on epidemiology, clinical presentation, diagnostics, treatment, and follow-up. Achieved scores of different specialists managing patients with CD were compared and regional differences in patients' knowledge were analyzed. Results: Questionnaire was completed by 1381 HCPs and 2262 CD patients or their caregivers from Croatia, Hungary, Germany, Italy, and Slovenia. Mean score achieved by HCPs was 50.9%, and by CD patients 56.4%. Pediatric gastroenterologists scored the highest (69.4%; P < 0.001). There were significant differences in knowledge of patients from different CE regions with German participants scoring the highest (58.3%). Members of CD societies scored higher compared with nonmembers (mean score 58% vs 53.2%; P < 0.001) and patients diagnosed less than 5 years ago scored higher compared with those diagnosed more than 10 years ago (mean score 57.3% vs 54.6%; P < 0.001). Conclusions: The knowledge about CD among HCPs and CD patients is not satisfactory. Further awareness-raising and learning activities are needed to improve HCPs' knowledge and to minimize the number of unrecognized patients and unnecessary diagnostic delays. Patients should be better informed about their disease to reach higher compliance with the gluten-free diet
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
coeliac disease
Megjelenés:Journal Of Pediatric Gastroenterology And Nutrition. - 72 : 4 (2021), p. 552-557. -
További szerzők:De Leo, Luigina Dolinsek, Jasmina Gyimesi Judit Klemenak, Martina Koletzko, Berthold Koletzko, Sibylle Koltai Tünde Korponay-Szabó Ilma (1959-) (gyermekgyógyász) Krencnik, Tomaz Milinovic, Marina Not, Tarcisio Palcevski, Goran Sblattero, Daniele Werkstetter, Katharina (gyermekgyógyász, gasztroenterológus) Dolinśek, Jernej
Pályázati támogatás:Interreg Central Europe CE111
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8.

001-es BibID:BIBFORM096511
Első szerző:Riznik, Petra
Cím:Diagnostic Delays in Children With Coeliac Disease in the Central European Region / Riznik Petra, De Leo Luigina, Dolinsek Jasmina, Gyimesi Judit, Klemenak Martina, Koletzko Berthold, Koletzko Sibylle, Korponay-Szabó Ilma Rita, Krencnik Tomaz, Not Tarcisio, Palcevski Goran, Sblattero Daniele, Vogrincic Matej, Werkstetter Katharina Julia, Dolinsek Jernej
Dátum:2019
ISSN:0277-2116
Megjegyzések:Objectives: Coeliac disease (CD) is a systemic autoimmune disorder affecting about 1% of the population. Many patients remain undiagnosed or are diagnosed with substantial delay. We assessed diagnostic delays in symptomatic CD children in Central Europe (CE). Methods: Paediatric gastroenterologists in 5 CE countries retrospectively reported data of their patients diagnosed in 2016. Age at first CD-related symptom(s), first visit to paediatric gastroenterologist and confirmed diagnosis were used to determine diagnostic delays. Results: Data from 393 children (65% girls, median age 7 years, range 7 months to 18.5 years) from Croatia, Hungary, Germany, Italy, and Slovenia were analysed. Median duration from first symptom(s) to visit to paediatric gastroenterologist was 5 months (range 0-10 years; preschool 4 months, school-aged 5 months), and further duration until final diagnosis was 1 month (range 0-5 years) with significant regional differences (P < 0.001). Median diagnostic delay was 6 months (range 0-10 years; preschool 5 months, school-aged 7 months). Type of clinical presentation had little, however, significant effect on delays. Reduced body mass in delays longer than 3 years compared with delays shorter than 1 year was found (z score -0.93 vs -0.39, P < 0.05). Conclusions: Time from first symptoms to CD diagnosis in children in 5 CE countries is slightly shorter compared with few other small paediatric studies, and significantly shorter than reported for adults. Nevertheless, delays of more than 3 years in 6.6% of children are worrisome. Raising awareness about the variable symptoms and implementation of reliable diagnostic tools will further reduce diagnostic delays.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
coeliac disease
diagnostic delay
Megjelenés:Journal Of Pediatric Gastroenterology And Nutrition. - 69 : 4 (2019), p. 443-448. -
További szerzők:De Leo, Luigina Dolinsek, Jasmina Gyimesi Judit Klemenak, Martina Koletzko, Berthold Koletzko, Sibylle Korponay-Szabó Ilma (1959-) (gyermekgyógyász) Krencnik, Tomaz Not, Tarcisio Palcevski, Goran Sblattero, Daniele Vogrincic, Matej Werkstetter, Katharina (gyermekgyógyász, gasztroenterológus) Dolinśek, Jernej
Pályázati támogatás:Interreg Central Europe CE111
Egyéb
EFOP-3.6.1-16-2016-00022
EFOP
NKFIH 120392
Egyéb
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9.

001-es BibID:BIBFORM072050
Első szerző:Werkstetter, Katharina
Cím:Accuracy in Diagnosis of Celiac Disease Without Biopsies in Clinical Practice / Werkstetter Katharina J., Korponay-Szabó Ilma Rita, Popp Alina, Villanacci Vincenzo, Salemme Marianna, Heilig Gabriele, Lillevang Sren Thue, Mearin Maria Luisa, Ribes-Koninckx Carmen, Thomas Adrian, Troncone Riccardo, Filipiak Birgit, Mäki Markku, Gyimesi Judit, Najafi Mehri, Dolinsek Jernej, Dydensborg Sander Stine, Auricchio Renata, Papadopoulou Alexandra, Vécsei Andreas, Szitanyi Peter, Donat Ester, Nenna Rafaella, Alliet Philippe, Penagini Francesca, Garnier-Lengliné Hélene, Castillejo Gemma, Kurppa Kalle, Shamir Raanan, Hauer Almuthe Christine, Smets Francoise, Corujeira Susana, van Winckel Myriam, Buderus Stefan, Chong Sonny, Husby Steffen, Koletzko Sibylle, ProCeDE study group
Dátum:2017
ISSN:0016-5085
Megjegyzések:BACKGROUND & AIMS:The guidelines of the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition allow for diagnosis of celiac disease without biopsies in children with symptoms and levels of immunoglobulin A against tissue-transglutaminase (TGA-IgA) 10-fold or more the upper limit of normal (ULN), confirmed by detection of endomysium antibodies (EMA) and positivity for HLA-DQ2/DQ8. We performed a large, international prospective study to validate this approach.METHODS:We collected data from consecutive pediatric patients (18 years or younger) on a gluten-containing diet who tested positive for TGA-IgA from November 2011 through May 2014, seen at 33 pediatric gastroenterology units in 21 countries. Local centers recorded symptoms; measurements of total IgA, TGA, and EMA; and histopathology findings from duodenal biopsies. Children were considered to have malabsorption if they had chronic diarrhea, weight loss (or insufficient gain), growth failure, or anemia. We directly compared central findings from 16 antibody tests (8 for TGA-IgA, 1 for TGA-IgG, 6 for IgG against deamidated gliadin peptides, and 1 for EMA, from 5 different manufacturers), 2 HLA-DQ2/DQ8 tests from 2 manufacturers, and histopathology findings from the reference pathologist. Final diagnoses were based on local and central results. If all local and central results were concordant for celiac disease, cases were classified as proven celiac disease. Patients with only a low level of TGA-IgA (threefold or less the ULN) but no other results indicating celiac disease were classified as no celiac disease. Central histo-morphometry analyses were performed on all other biopsies and cases were carefully reviewed in a blinded manner. Inconclusive cases were regarded as not having celiac disease for calculation of diagnostic accuracy. The primary aim was to determine whether the nonbiopsy approach identifies children with celiac disease with a positive predictive value (PPV) above 99% in clinical practice. Secondary aims included comparing performance of different serological tests and to determine whether the suggested criteria can be simplified.RESULTS:Of 803 children recruited for the study, 96 were excluded due to incomplete data, low level of IgA, or poor-quality biopsies. In the remaining 707 children (65.1% girls; median age, 6.2 years), 645 were diagnosed with celiac disease, 46 were found not to have celiac disease, and 16 had inconclusive results. Findings from local laboratories of TGA-IgA 10-fold or more the ULN, a positive result from the test for EMA, and any symptom identified children with celiac disease (n = 399) with a PPV of 99.75 (95% confidence interval [CI], 98.61-99.99); the PPV was 100.00 (95% CI, 98.68-100.00) when only malabsorption symptoms were used instead of any symptom (n = 278). Inclusion of HLA analyses did not increase accuracy. Findings from central laboratories differed greatly for patients with lower levels of antibodies, but when levels of TGA-IgA were 10-fold or more the ULN, PPVs ranged from 99.63 (95% CI, 98.67-99.96) to 100.00 (95% CI, 99.23-100.00).CONCLUSIONS:Children can be accurately diagnosed with celiac disease without biopsy analysis. Diagnosis based on level of TGA-IgA 10-fold or more the ULN, a positive result from the EMA tests in a second blood sample, and the presence of at least 1 symptom could avoid risks and costs of endoscopy for more than half the children with celiac disease worldwide. HLA analysis is not required for accurate diagnosis. Clinical Trial Registration no: DRKS00003555.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
celiac
Megjelenés:Gastroenterology 153 : 4 (2017), p. 924-935. -
További szerzők:Korponay-Szabó Ilma (1959-) (gyermekgyógyász) Popp, Alina Villanacci, Vincenzo Salemme Marianna Heilig, Gabriele Lillevang, Sren Thue Mearin, Maria Luisa Ribes-Koninckx, Carmen Thomas, Adrian Troncone, Riccardo Filipiak, Birgit Mäki, Markku Gyimesi Judit Najafi, Mehri Dolinśek, Jernej Dydensborg Sander, Stine Auricchio, Renata Papadopoulou, Alexandra Vécsei Andreas Szitanyi Péter Donat, Ester Nenna, Rafaella Alliet, Philippe Penagini, Francesca Garnier-Lengliné, Hélene Castillejo, Gemma (gyermekgyógyász, gasztroenterológus) Kurppa, Kalle Shamir, Raanan (gyermekgyógyász) Hauer, Almuthe Christine Smets, Francoise Corujeira, Susana van Winckel, Myriam Buderus, Stefan Chong, Sonny Husby, Steffen Koletzko, Sibylle ProCeDE study group
Pályázati támogatás:OTKA-101788
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