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European Journal of Pediatrics
Published in:

19-07-2024 | Celiac Disease | RESEARCH

With or without biopsy in coeliac children?—Impact on dietary compliance and quality of life

Authors: Evelien Antonius, Yenny Kho, Lian Roovers, Margreet Wessels

Published in: European Journal of Pediatrics | Issue 10/2024

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Abstract

Critics of the ESPGHAN guidelines on CD question the acceptance of the no-biopsy policy by patients and parents against the backdrop of a lifelong diagnosis. The aim of this study was to investigate the impact of the no-biopsy approach on dietary adherence and health-related quality of life (HRQOL). In this retrospective cohort study, patients ≤ 18 years diagnosed with CD between 2007 and 2017 were sent two questionnaires: a dietary interview and a CD-specific HRQOL questionnaire (CDDUX). Included patients were divided into group A (with biopsies <2012), B (with biopsies >2012) and C (without biopsies >2012). Fisher exact test and ANOVA were used to analyze the impact of the new diagnostic strategy. Forty-seven percent (82/173 patients) consented to participate in the study. Of them, 63% had a biopsy-confirmed diagnosis (40% before 2012 (group A), 23% after 2012 (group B)), and 37% were diagnosed without biopsies (group C). Dietary compliance was similar in all groups (p = 0.67). Group A scored significantly better on the subscale ‘Having CD’ compared to both groups diagnosed after 2012 (p = 0.003). Group A and group C seemed to score better on the total CDDUCX score when compared to group B (86 and 80% versus 61% respectively, p = 0.13). This was also observed within the subscale Diet; Group A and C scored significantly better than group B (62 and 72% versus 39% respectively, p = 0.09).
Conclusions: Omitting duodenal biopsies in the diagnostic approach of our CD cohort had no adverse effect on dietary adherence and HRQOL.
What Is Known:
• Since the publication of the ESPGHAN guideline of 2012, duodenal biopsies are no longer obligatory in the diagnostic approach of CD if IgA-antibodies for transglutaminase 2 are ≥10× ULN, endomysial antibodies are positive in a second blood sample and the patient/family agrees with the no-biopsy approach.
• Literature on the effect of the no-biopsy approach on dietary adherence and HRQOL is scarce.
What Is New:
• Omitting duodenal biopsies does not influence dietary adherence and quality of life.
• In our cohort, lower quality of life measured with the CDDUX subscale ‘Having CD’ is more likely to be related to shorter disease duration than to the diagnostic approach.
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Metadata
Title
With or without biopsy in coeliac children?—Impact on dietary compliance and quality of life
Authors
Evelien Antonius
Yenny Kho
Lian Roovers
Margreet Wessels
Publication date
19-07-2024
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Pediatrics / Issue 10/2024
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-024-05686-1

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