Interpretation and implementation of the revised European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines on pediatric celiac disease amongst consultant general pediatricians in Southwest of England

  • Siba Prosad PaulEmail author
  • Helen Louise Adams
  • Dharamveer Basude
  • Collaborators
Original Article



Celiac disease (CD) is a lifelong condition with significant morbidity and requires an accurate diagnosis. Guidelines for pediatric CD were revised by the European and British Societies of Paediatric Gastroenterology Hepatology and Nutrition in 2012 and 2013, respectively. New recommendations introduced non-biopsy pathway (NBP) of diagnosis for a selective group of symptomatic children whose anti-tissue transglutaminase (anti-tTG) antibody titer is greater than ten times upper limit of normal. A clear understanding of the guidelines amongst consultant pediatricians will ensure all children with suspected CD receive a prompt and secure diagnosis. The aim of this study was to establish the interpretation and implementation of the revised guideline for CD amongst consultant general pediatricians in Southwest England (SWE) during the study period.


Telephone/email survey was conducted amongst consultant general pediatricians (n ≈ 140) working in 12 secondary care hospitals across SWE. The survey included eight questions incorporating three main themes: understanding of diagnostic pathway particularly for non-biopsy diagnosis, awareness of laboratory tests involved, and variations in practice in relation to the revised guidelines.


Responses were available from 101/140 (72%). One hundred respondents were aware of the revised guidelines for diagnosing CD. However, only 17 respondents stated all the criteria of the guideline required for diagnosis by NBP, with further 17 seeking immediate advice from a specialist. Forty-four listed both the criteria for HLA-DQ2/DQ8 testing applicable to pediatricians. Forty-nine out of 100 pediatricians would commence gluten-free diet only after all the results were available. Thirty-three pediatricians also considered asymptomatic children with high anti-tTG titer eligible for diagnosis of CD by NBP.


There is a need for improved understanding of revised CD guidelines amongst consultant general pediatricians especially while using the NBP and requesting HLA-DQ2/DQ8 testing.


Asymptomatic children Celiac disease ESPGHAN guidelines General pediatricians HLA-DQ2/DQ8 haplotype Questionnaire survey 


Author contributions

All the authors have contributed equally to the manuscript.

Compliance with ethical standards

Competing interests

SPP, HLA, DB, and Collaborators declare that they have no competing interests.


The authors are solely responsible for the data and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, or the printer/publishers are responsible for the results/ findings and content of this article.


Alison Rushforth - Gloucestershire Royal Hospital, Gloucester

Christopher Knight - Musgrove Park Hospital, Taunton

Camelia Vaina - Yeovil District Hospital, Yeovil

Girish Gowda - Great Western Hospital, Swindon

James Hart - Royal Devon and Exeter Hospital, Exeter

Loh Ne-Ron - Royal United Hospital, Bath

Matthew Thorpe - Royal Cornwall Hospital, Truro

Rebecca Cordingley - North Devon District Hospital, Barnstaple

Samuel Broad - Derriford Hospital, Plymouth


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Copyright information

© Indian Society of Gastroenterology 2019

Authors and Affiliations

  1. 1.Department of PaediatricsTorbay HospitalTorquayUK
  2. 2.Department of Paediatric GastroenterologyBristol Royal Hospital for ChildrenBristolUK
  3. 3.Medical SchoolUniversity of BristolBristolUK

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